HomeMy WebLinkAboutBLDG-19-005120 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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JOBSITE ADDRESS Ia2iDfl .t x ._ 1OWNER'S}NAME I• r _.__..: ^:^�G k '_ _._OWNER ADDRESS r ? RrVS V4 S� C ,thl .-=?TELL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL I:.11 EDUCATIONAL I RESIDENTIAL , i
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CLEARLY NEW[.,1RENOVATION:IS REPLACEMENT:F,,,,; PLANS SUBMITTED: YES I;_ NO(
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APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ! i ► If L 1 j I 1 :. li I —lc,-. 1
BOOSTER 1 .1 I L' �' £I Jr:. 1 1 l 1 1 i . ,zl...,.
CONVERSION BURNER I..:. . UT—. II 'I ._.� i..,,. p � . I '1 . v,'L_.. tl I :-.Jr_-„ l.. _ _11r... i
COOK STOVE 1 I .I I I I [ _IJr. L 1 "1 -1
DIRECT VENT HEATER I i r 11 i 1 I 'r 11. ` 11
DRYER I ; . ._"
IL 11 i_ ;.[ 'I I ti . I II.. II. l _C ri _I..�w
FIREPLACE 1 -;, - _M _ ___ , W
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FRYOLATOR
FURNACE r l 'I11 L I �I 11
GENERATOR 1 _ ,f 1 I If I iT i ,:.._, d _i fl AL
GRILLE
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INFRARED HEATER 1 _. . 11 31 C I ( _11 1 I_ AI °L rl I
LABORATORY COCKS 1 Ilj' II 1 _ I i 1 .1 `• I�n„ i t I ;I I !I
MAKEUP AIR UNIT I -_, =I it I _ ;I ,. i f 1 FT 'f 1 1 ;I 11. .- 1
OVEN L .,---1
�I 11 ;1_ _ill.: I `. 41 1 3 I ... 11 . . 11 :1 ::.'1., _111,
POOL HEATER I ii 1 F1 r . ! I 1 r 11..
ROOM 1 SPACE HEATER
ROOF TOP UNIT I :`ll FI ( 1 r I I . I I 1 I ,i l7 1 T. 4
TEST I V 1 I 1 I I I ,1 0 L
UNIT HEATER 1 11 1 _ I 1 I ,I xl I 1 I i J r:- :
UNVENTED ROOM HEATER I IJ I 'r II I I .l if . I ., tL ( 1 tr Ii _ :1
WATER HEATER 1 .i I I 1I i 1 ;i" 'I I- - 1 P"` ; . .
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES , NO (_-j
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1` ,I OTHER TYPE INDEMNITY 1,:..:#)
BOND I,.,,,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 El AGENT r::,I
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 accurat e best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit P I rov 'on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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PLUMBER-GASFITTER NAME Spencer Hallett LICENSE# 16224 I Si
MP D MGF El JP( ) JGF I+_j LPGI( ,] CORPORATION M.. #13834 •PARTNERSHIP 1„ #I 1 LLC I„,#I 1
COMPANY NAME:ISpencer Hallett Plumbing and Heating Inc I ADDRESS 1381 Old Falmouth Rd Unit 36
CITY IMarstons Mllls i STATE
I Ma I i Z IPj02648TELI508 428-6080 j
FAX 8-7991 508 42 CELL 1EMAILIspencer@hallettplumbing,com
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