HomeMy WebLinkAboutBLDG-23-9345 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
�_ FI v (�
CITY r'/R p_ Q.�'t_`E_ _ ___J MA DATE (p�,R,J,n2 ,�PERMIT# ,R L'0 G-2.3— 9311
JOBSITE ADDRESS��aL M ___H_____--- 1--------- --._
. LSE � 21_Ur= OWNER'S I M
_ G
OWNER ADDRESS .� _ ,, __ i TELp arc. 1FAX I' _-.-,..[
TYPE OR Q.00CUPANCY TYPE COMMERCIAL U ]EDUCATIONAL � RESIDENTIAL Ai
0
PRINT
CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:10 PLANS SUBMITTED: YES 0 NO U
APPLIANCES 1 FLOORS—I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILERJ .. '_ . _ J.
BOOSTERii
{
CONVERSION BURNER IN. _-_ . - __ . I, ' r - _ ' - --.-- -
COOK STOVE . - I I I. L
DIRECT VENT HEATER
DRYER ,
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR _ � � ,
GRILLE ,... ;‘ I ., , I - i - I . ! I' .
INFRARED HEATER J. 1 1 i.
, _ w W0. i WAN/.M Y'AA■ Li
LABORATORY COCKS
MAKEUP AIR UNIT ...: w, ' 1.1111 . ' i� ,V i
OVEN , f ' ,. 7 Iitlowl 1
iI 1. . �.-J
POOL HEATER _�. _ � _.
ROOM/SPACE HEATER 1 _ _ ; _ _ I - I 1C t
ROOF TOP UNIT a
TEST , _ . - ibiti I
UNIT HEATER .. _.. 1` ,- — ,UNVENTED ROOM HEATER , i 1J
WATER HEATER _ 13UT r: MI6 , f ti ft r i
OTHER I I Xi
-a 1 I ! , . i I I 1
':...�._...1 _ _, _.,._., _ ,.Il_,[ � 1`Buz+- 1 -�- I. ..„. --n«...m •.w-..,�. 1. -.r «...„„.„..1
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES EJ NO Li
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [] OTHER TYPE INDEMNITY U BOND U
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 (D AGENT ED
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 a rate tot st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli h all P t provision of the -
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Francois Paravisini —__--Y —I LICENSE# 15211-1 RE
MP[,„l MGF[R JP[ JGF[ I LPG'El CORPORATION[1# 4288 __ PARTNERSHIP El#L__~„_I LLC[ #1
COMPANY NAME:Snows Fuel Co �ADDRESS 118 Main St 1
CITY Orleans MA -- _ ___ =__.__T...____—_I STATE MA ZIP 02653 TEL 508-255-1090-__-_-________. _1
FAX y _ CELL �K 6 1EMAIL(Baysidet�theca ecodpiumbers.com _
CK-6- 333, ob J22 f 2, .r SO,eb