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Home My WebLink AboutBldg-20-003059 .ramp MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY � MA DATE' PERMIT# Der-oV 00 3� `� , ,,r,,,,,,,,rrrr,,,rrrr„rrr,,,, ,r,,,,r,,,,,,r,,,,,,.,,,,,,,,,,,r,,,,,,,,,,�,,,,�,w,,,Nurr,� a?- , , r,r,,,,,,,,, l �' 40:jfjgatjr,�,rrr, rrr ,,, f JOBSITE ADDRESS rrrrrrrrr, ,-, jjjS rrrrrrrrrrrrr� / / j OWNER'S NAME ` IID�T c4„,,,,,,u,,,,,H,,,,,,,,,,,�,,,,u,,,,,,,,,,,,,,,,,,,,u G OWNER ADDRESS i ,,, TELL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY �_.., 6.....�., t... , r.....,,.., NEW:j,,,,,r„j RENOVATION:J REPLACEMENT:lrr, PLANS SUBMITTED: YES,or NO=„ro, APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ __ BOOSTER CONVERSION BURNER COOK STOVE 111111111111MOINISINIIIIIIINICOMMIIMIIIIIIIIIIIMMOIM DIRECT VENT HEATER 111110111111111111111111111111111111110101111110111111.11111111111111111111111111110 DRYER 11111,111.1101101111.1101.1111111111111111111111011111111111111111111111111111111111111111111 FIREPLACE MillialliMillit11111111111.1.111111MOINFIIIIIIIIIIIIIIIIII FRYOLATOR 1111111111111111111111111111111.1111001MOMMIIIIIIIIIIIIIIMIIMISII FURNACE 1111.111111.11.1011111111.10111011111MMIIIIIIIM10111101111110111111 GENERATOR GRILLE11111111111111111111911111M1,1111111•1011.1111.111111111111111MUMME INFRARED HEATER 001 LABORATORY COCKS MAKEUP AIR UNIT / N / �/ OVEN ow POOL HEATER ,rst i ROOM I SPACE HEATERIIINWN,011111111111111.1111111101111.1111111011.101111111101111111110.011111111 ROOF TOP UNIT a / /VIIIIIJIII TEST 111 � /_ 111.1111.111111111111111111111111111111 UNIT HEATER 1101111111111011111111111111111111111111111M11111111.1111111111111M1111111111 UNVENTED ROOM HEATER / WATER HEATERw.,... ��.._.............................,.m...._m._.. ..........._ 11 1101 11111111111 11 1 f111 1 11111111 11111111111.11111 OTHER?w.._w_e..w_w_ _�.��................................._......w...............,.......` ///Oe0/O.O///////,®///,U/ ///HXU/,�,GC9///.fi/H///GY//l////////////9////H////9�//L!r//////9////////r1.�� % A,.wruurruururrur rru rru rur rrr nr ....rr.�.mruui uu uiruur a ..,w«.r rrrruurrrr` / /./r 01011 �� /�� /. / rL rwuiuuruiuuiuuuuirwiwruuuwuruiuiuiiiuuuuuuuiuuuuuuuiwuuiouuwuwuwuuiiiuuuiiuiuuiiuuuuiurw 1110011101111111111 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO VLF I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ty; LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY BOND �,,,,,,,, i L„p 1, OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT r,,,f SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Sean Hanrahan r LICENSE#1 15822— f SIGNATURE MP MGF JP JGF r LPG! .... CORPORATION .......#I_._......................._..._...._._. # .,,...........,,,..,.,._...,... �,,,,�,,,/ ,� PARTNERSHIP-,,, ib, z LLC rrrurHrrrrr,,,,,,,,,, COMPANY NAME:-Sean Hanrahan Plumbin�randHeatinq J ADDRESS PO BOX 688 ��r�rdrrrr�r�rrrrrrrrrrr CITY Centerville STATE 1,,,, MAC ZIP r02632,,,,,,,,,, x�,,,,,,,, TEL i 774 238,0286 FAX 508 775 4615 ,CELL:same ;EMAIL:hanrahan lumbin mail.com � . WrrrWrH,,,,,,,,,��,,,,,,,A, r�r< ,� ,,,,rrr, ,,,,� C 1 9 Q cO LAP ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# /G`�"'2 PLAN REVIEW NOTES A�T �a/ r I� , 0 /