HomeMy WebLinkAboutBldg-19-005528 CITY CI A ` 1 MA DATE 3--a-a ,‘") PERMIT#I4 96"/7"049 fc:2„'
' JOBSITE ADDRESS Co o A\w--S #) & i1 DINNER'S NAME '17=)�-2_'z_.c r-
G OVAIER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW✓ RENOVATION: REPLACEMENT: PLANS SUMMED: YES NO t/
APPLIANCES Z FLOORS-. 9SM 1 2 i 3 4 5 6 : 7 8 9 10 11 12 13 14
WEER
BOOSTER
CCMIBEICN BURNER '
COCK S OiAE I ' 1
DIRECT VE IT HEATER •
DRYER '
FRYOIATOR
RiRtMCE
GENERATOR
GIELE
LNIONNORY COCKS
POOL NEATER
ROCMISPACEIEATER I Iv
ROOFTOPUNIT i '
TEST
UNIT HEATER ,
ENAIEN 'iRXNEEATER
MTER HEATER
OTHER
•
INSURANCE co4ERAGE
I have a client illatinsurance policy or its substantial equitable which meets the requirements of SIGL.Ch.1Q YES • NO
I E YOU CHEMED YES.PLEASE aDICATE THE TYPE OF COVERAGE BY CHECK*6 THE APPROPRIATE BOX BELOW
UABLRY MdSURANCE POUCY • OTHER TYPE INDEMNITY BOND
E>M>81EWSNERIRMICE WANElt I as mere that the Scene dIgualissitte asuraaoe careraoewqired by Chapter 142 0[the
Nessadiuseds Genial L .and that eery sgnawte en this peemiit application amities this eagdiamet.
CHECK ONE ONLY: OMMER AGENT
SIGNATURE OF OWNER OR AGENT
I Witty cuisti Beta tormeuiekandsemen I him subialled or woad impeding the •- - as - _ .
andlidellations perfonerd under Me permit baud for this application wi• in-- • - of time
Messmetcomils Stele Plumbing Cods and Chapter 142 of the General Lam.
NAME Chris Holcomb LICENSE# 11609 SIGNATURE
MP ' MGF JP JGF LPG' CORPORATION # 3586 PARTNERSHIP # LLC #
COMPANY NAME: David Holcomb Plumbing&Healing INC ADDRESS P 0 Box 170
CITY Calende TATE MA ZIP TEL 508-420-0077
FAX 508-420-0036 CELL 508326-5598 L chnsett mbpkxnbirg•com
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