HomeMy WebLinkAboutBLDG-20-002712 P7/9 i) Piegn C e /
MASSACHUSL 1 i S UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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._ ,- --=--- CITY!Tovm of YARM 0 i.)7111- 1 MA DATE, .. 1 i PERMIT#/A4)ixia-adz 7/2
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. JOBSITE ADDRESS! ,I I'S (,r c,,, 2f4ca1-
,. g OWNERS NAME 1 Andrec, (Y9C&e,e_ 1
• GOWNER ADDRESS I - I 1E1(5o f),?•3 7—376 FAX 1
TYPE-OR
OCCUPANCY TYPE COMMERCIAL u RafalaidiAdM E D RESIDENTIAL '
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLA :4 m : II; NOV 7 21 PLANS SUBMITTED: YES 0 NOD
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APPUANC.ES 1 FLOORS—I BSA i - .1P1 1 2 3 5 6 7 -- 8 9..i 10 11 12 13 14
BOILER _
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BOOSTER. CONVERSION BURNER
COOK STOVE - Milli
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DIRECT.VENT HEATER
DRYER
FIREPLACE -
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FRYOLATOR
FURNACE
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• GENERATOR -
GRILLE
I 1=,-it ,a • -1- 16as INFRARED NEATER flimi.11111111111111 Mili.Minn IMMII MIN AM j11111111 1111111 mom MIK INN ow miff
LABORATORY COCKS Am mini Et En•Nor mum;Ail:1 :-0,g7,, •..A.j keu.r-411 „ riaw ja.
MAKEUP AIR UNIT MIMI MI MINK MIK MINI 111111 NIL-ig — 1/L `k..1.: ;..L.Z1 Li./Li Uiti ti ,LLLI lit
OVEN' INF ME 11111/11 mot Alit RIF MIR Iiii: Wall 414.! IL,L,,-' ,1. .=; 0121i.-=IL ANT
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POOL HEATER • . _ ,_ _ .... . T , ,...
ROOM/SPACE HEATER
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ROOF TOP UNIT -
III
TEST - - -
UNIT HEATER
UNVEWFED ROOM HEATER
OTHER ,, .41 II
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INSURANCE COVERAGE
I have a current liability insurance policy or Os substantial equivalent which meets the requirements of MGL Ch. S.142 YE' Z(iNO U
I F YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY II( OTHER TYPE INDEMNITY I:3 . BOND U
OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the ksurance 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 0 AGENT U
SIGNATURE OF OWNER OR AGENT '
I hereby cerfrfy that all ci the&tab and informalion I have submitted or entered marring this application are true and accurate to , best of my knowledge
and that all plungAng work and irstalefrons performed underthe permit Issued for this application writ be in compiler= ,,. ' F) provision of the
Massachusetts State Pkenbing Code and Chapter 142 cite General Lees.
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PLUMBER-GASFITIER NAME 1 lieu;0 fric-Br:(je. I LICENSE#1 i 1 69 01 - =7.-- - - SIGNATURE
VP 121 IvIGFE3 JP 0 .IGF ID LPG!0 CORPORATION[iitt .9 86.F C.1 PARTNERSHIPOO. (tic at_ 1
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COMPANY NMAEi Va.,raY)c-gr;de Plum-I-/leaf .11c1 ADDRESS i I Or,c1).i4 i7441. .• i
CITY W. Veirryv)(41% • STATE 11/7.41 ZIPS Oac7.3 raj (54 )-771?- 4 554 1 •
FAYIAJA-yrto-6-7g51 cat160g.3G4-g-7,941Emal kne)Cp 1 U(3/, i) 6 co NI c.xts4,,, ne_...i- i
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