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HomeMy WebLinkAboutBLDG-20-002447 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '_ r' BLDG-20-002447 ... . CITY LYARMOUTH MA DATE October 29,2019 PERMIT# 7 t4f' '9' r JOBSITE ADDRESS 31 HOLLY LN OWNER'S NAME HILDRETH ANDREW J G OWNER ADDRESS HILDRETH PAULA M 37 FARMINGTON RD WEST ROXBURY MA 02132 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW: Li RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El FIXTURES FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LAEORATORY COCKS MAKEUP AIR UNIT OVEN ' POOL HEATER RO,):,.1/SPACE HEATER ROOF TOP UNIT UNIT HEATER UNVENTED ROOM HEATER W TER HEATER 1 .7 01 rhr R --- 0-7'I=N DESCRIPTION: INSURANCE COVERAGE: I ha- a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES © NO❑ IF i CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAL LY CHECKING THE APPROPRIATE BOX BELOW LIAEII_1, INSURANCE POLICY ❑ UTHER OF INDEMNITY BOND ❑ 0' `.:ER'S INSURANCE V' IVER: I am aware that the licensee clnc.s uo Ilive the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that me's'.gnature on this permit application yia'ives this requirement. SICNAT'URE OF OWNER OR AGENT I i , :r.certif,yi tiim ali of tie details and information I have suaniatcH ._ :nter'S regarding this application are true and accurate to the best of my knowledge ac ht all plur hi . rk aril inslallat 011S performed under the 1,^.rn:l is ur;;i for this application will be in compliance with all Pertinent provision of the iv,,aachusetts Stile Hirai "-a Code and Chapter 142 of the G. marl Laws P!.- '.RER-GASFITTER NA tE Richard Whiteside 7 LICENSE# L58EO SIGNATURE IV^.r :• J MGF ❑ JP❑ JGF❑ LPGI ElCORPORATION El# — PARTNERSHIP ❑# LLC ❑# CC:.O,;NY NAME E CHARD J WHITESIDE ADDRESS. 29 MAPLE TER, !SOUTH'CE v''N1S 1 STATE MA 1 ZIP 026603651 TEL FAX, I CELL EMe,I', L_ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES