HomeMy WebLinkAboutBLDG-20-002090 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
tlCITY 4_,,,,,,,,,-., , MA DATE PERMIT#4406w-do aciP,
JUTE ADDRESS 1 to(, Te551-11JA f-A VP,— I miNER's NAME I
..... G OWNER ADDRESS 1 __I TEL IFAX _ 1
TYPE OR
OCCUPANCY TYPE COMMERCIAL u EDUCATIONAL LI RESIDENTIAL 3.----
PRINT
CLEARLY NEW:D RENOVATION:0 REPLACEMENT:Z PLANS SUBMITTED: YES Et NOD
APPLIANCES 1 FLOORS-+ BSM 1 1 2 I 3 4 5 6 7 j 8 9 10 11 12 13 14
BOILER 111111LM111111/1111111,7T ,----1-- - 111111111111111, -MIL
BOOSTER
CONVERSION BURNER IA - _ , .L.,,..,.! __: '
uniegit 1111111111M11111111
COOK STOVE Wilitaillrant. Atil_Wr-wWWWiMmariir___Amk—
rDIRECT VENT HEATER PLORM11MMEHM-1 ' -
Ot..II.I.. ,, __. ,11 W''IgIlIinNEkiml it-M______:Mi0i1lli1.1i,1rM11I.M111111.1 1113IM0PImlA.iLIk-Mi1M-1111M111EMW1111•R
DRYER MMMM 1ltl1M-11n
FIREPLACE M — 7Mffift
FRYOLATOR , MWWWWW/
FURNACE M
GENERATOR isM"w B
GRILLE MW ffr mrmnI1N1a
INFRARED}EAt aW . 11..A1E"k
-iistM,IIIIIII
LABORATORY COCKS Wrilitairilir 111111WariMiiiiiiniarglirMilir
MAKEUP AIR UNIT !IIIIIrlimiur amorammi—linowvirirramir
OVEN ! • ___,_: AlliliSiii, luiringuntintiorinumerinamt
POOL HEATER - _ MIR 1111111MillitillialialiM
ROOM i SPACE HEATER ;• • Eiratilifillt 1111111,11/11EMENIFINIFINIE11111
ROOF TOP UNIT Illtlignitir MINNWPWWW-Milai
TEST ' - ----. ---.`"" mi"`
UNIT
UNIT HEATER * . , _ wenillinintweriiirimorWriew
UNVENTED ROOM HEATER Nt IMK . 'WWI IS11611111M-Maini
WATER HEA I tH _
OTHER- ili
mini...,
.... _ ........__ , :. ._. , ._ , i ., ,
- -, .• MIR 1111111E111111111 , , 1111111: AMU INSURANCE COVERAGE
I have a current liability insurance,policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 71 OTHER TYPE INDEMNITY [J BOND 0
— - _OWNER'S INSURANCE WAIVER:lam 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 I'NE ONLY: OWNER r -cFNT El
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the detaits and information I have submitted or entered regarding this application are L.,-and..,.....-4- .the .,-•-t of knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in ,. r _ - .17_, _ t ,. t,,i.-...,... of the
Massachusetts State-Plumbing Code and Chapter 142 of the General Laws. /'
A 'i LI —
PLUMBER-GASFITTER NAME ....Linis IVAlevine , 1 LICENSE#-Ii iTn llv ^G• • I -. . --"••-•,—,
MP 0 MGF lE,1 JP ri JGF Li LPG!71 CORPORATION D# 2931 I PARTNER", IP 04,k 1 LLC 714.. j
COMPANY NANIEiDevine P&H Inc. I ADDRESS 8 Jan Sebastian Dr.,Unit 23 I
CITY (Sandwich STATE I Ma (ZIP 02563 (TEL 508-888-9002 FAX(508-888-8313 I CELL 774392-1741 (EMAIL dennis@cievine-plumbing.com I
OCT 15 101ti'
cfr#- 4 co
cc-.0-81'3
0