HomeMy WebLinkAboutBLDG-16-002867 CiW: 3Gtfe/nOGrk MP- DATE: // //-/( P.l✓ry i3L4P/6-00am7
• y JOESITE ADDRESS: g/1i-/l///�� "' OWNER'S l'k 4'W i7/'lo'® 'o
.I G OWNER ADDRESS: , ' �Qmin o etf ii TB-: F!;^
TYPE DP OCCUPANCY'TYPE G'CO v Jl=r.CLkL EDUCAi 10111;L ❑ RESIDENTIAL,�J
PRE 1 I d i ❑
CLEARLYN�=VJ:❑ RENO PATIO ❑ REPLACEMENT:}� PLANS SUBMI i I rO: YES❑ ND❑
I .APPLIANCES, FLOOR—F 1 Bsint 1 I 2 3 1 ! 1 5 1 0 1 7 8 1 9 1 10 i 1 1 12 I 13 I 1'
I BOILER I I I I I I I I
BOOSTER I I I I I I I I
I CONVERSION BURNER I j I I I I I I I I
COOK STOVE I I I I I I I
I DIRECT VENT HEAT t I I I I I I I I
I DRYER I I I I I I I I
FIREPLACE I I I I I I
FRYOLATOR ; I I I I I
FURNACE I I . I .
I GENERAATOR j I
I GRILLE I I I
INFRARED HEATER
I iL&BORA i DRY COCK I I
MAI4 UP AIR IMF I I ! I I I
I OVal
POOL HEATER. • .I I I I I
ROOM 1 SPACE HEAD I I I •
I RooF TOP UNIT I I I I I
ITEST I I I I I
I UNIT HEATER I I I I I
I UNV . ROOM HEATER I I 1 I I I
1 WATi tom;i2 I I I I I ' I
I I I I I I I
I - -I I I I I I I
I I I I
I INSURANCE COVERAGE
1 have a cent liafbiltvinsivance poHry or tt s bstn lal equivalent which mee4 the ra neri;s of NiGL Ch.1"22 YES ':4 NO ❑ f
. If you Irave chid l pl se indicate the type of coverage by checking the appropria;r box below. 1/3.3 *C7 4,r-1
LIABILITY INSURANCE PDUCY g OTHER TYPE INDEMNITY 0 Bom ❑
•
OWNER'S INSURANCE WAIVER:I am aware that the Iicensee does not have the insurance coverage required by Chapter112 of the ' a
Mia.ssachusei General Laws,and that my signature on this permit appficaden waives this requirement
CHECK ONE ONLY: OWNER❑ AGENT ❑
SIGNORE OF OWNER OR AGENT 1
hereby Deity tat all of tie details and iraormaton I have subrnraed(or entered)regarding This appGcafion are true and accurate tote best of my
Knowledge and that all plumbing work and inssllations performed under the perm?issued for this application will be in compliance wi all Pernnent
provision of tie IWassaohuseUs State Plumbing Code and Chapterl42 of the General Laws.
4I o NATUF
PLUl�iEERI�.ASL� I I I tkNA1\hE: /'✓��it /l ��� LICENSE./�1 y SIG
COMPANY NAME: i//jrirr; `//d e ADDRESS: // ( fI
CITY:4., ll.e,_i 76 ,.V STATE ,$ /. ZIP: 6 U 77 FAX:
TEL: CELL:7-2q—.6W`07efr EMAIL'
MASTER ER pg, JOURNEYMAN 0 LP INSTALLER❑ CORPORATION gt, 3 2 3 9 P;,R t i RS:ILP!_i= ac
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