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HomeMy WebLinkAboutBLDG-20-006000 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' r -1--. : 1^ yi' CITY I IC v wtp u�-1-�1 MA DATE S- J a--J c a o I PERMIT 4'"Li* d L�0�?0��0 tia JOBSITE ADDRESS (t I (.C'OILOct+ le-o( • OWItIER'S NAME F4,1;h'p t- Q '4k Eill Cr'S 4 €��T•T OWNER ADDRESS St a- ct..loo'IG TEL,56 r 1-31 tel S FAX TYPE OR PRINT TYPE COMMERCIAL 7 EDUCATIONAL JI RESIDENTIAL Cif Y NEW:1 1 RENOVATION:Li REPLACEMENT { I PLANS SUBMITTED: YES❑ NO APPLIANCES 1 FLOORS- BEM 1 ' 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BOILER - ,,�---__1---�1--_--IL__..., ,I- __._.�. .._ , ; BOOSTER ,r.�._ ,I 1 -— ---=?---:r---- I I--(_ ��_CONVERSIONBURNER .' _.._ - -- 'I r•- ,' COQI<STOVE !1 ++_ `_ — —i DIRECT VENT HEATER ��"I '�—A - _ 11_'7-1-1., . —tom --—.1._.,,,---`. ,„,„,_L._r..=L i1 a DRYER II �I t_ tl l -- II i ____ 1---_ _:1 -- 13 �- ' FIREPLACE _ it i.. ��._� �i it — -- T S— FRYOLATOR i ;i ' 1 ,� .II i � f=__ l�__ _ s ' FURNACE 1 I 1 . - ;_v_ i .. . I V t—- = A�z GENERATOR II it __ - 1 it it 'I GRILLE IL .(�i1 1 �I ' 1 _1r-`il �Ir:J 1 ', 11 h INFRARED HEATER I I—Th ..='1 i1__ �L 11-7_ _---r1. LABORATORY COCKS — f ti"Iil .._,_„ II _ It :il l 1 Fi ._ r ! ., _.. ty ,7T 1 MAKEUP AIR UNIT ' OVEN II .1.7.7'ir I �L_..,,' .. ��.�- —1 —i— --1 ETT POOL HEATER i.....:—.1 : '}}f I�� . 1_._ ai...� +, u � !r !1 . k `d._,., i l . .. ROOM/SPACE HEATER p '11 __II f t 1,1 `C�lI ';� -1____i_ ._,i 1 ROOF TOP UNIT I I I_ �! _ ?I 4 —II ]�___..,...3--.4__._ 1��..___...�I 4 -- ( TEST _._- �t ,x,..�:.�..._..^.; ..� ...�.�__._,_.._�—�—, ,�-, UNIT HEATER I . .�_ �.. jL ._iI 1 a 11_,�x i�._ . __ UNVENTED ROOM HEATER 1 "„_,:yl_,..'hi�..:v + __fir_ i'l I - J,_ L._.j WATER HE.ATEP. ?, tI I _ 1 i--,„—:_ : — __i + �- _ �� i OTHER . �7 `; +L j 1( { .1r.�. �. _,,_—`-�, --_.._,1r-,--.-,1 _I i1 . i�'?� _._ ---__ i' 1 11— _ I 11` _ I ` ..ter i" 1____ __ I--11 L U J _± li ._� C . its ._71 __It._ -� � �..' T I tt tr INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.-142 YES 11-1 O I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY I I BOND - OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 ot the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [ I AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co pliance:with all Pe:nentnent provision Massachusetts State Plumbing Code.and Chapter 142 of the General Laws �' PLUMBER GASF(1 iEP,NAME L e 4c r' �I.IL� �c� j LICENSE#I 45Coq SIGNATURE MP I I MGF Wr JP❑ JGF LPGI 7 CORPORATION{[14I —I PARTNERSHIP[]# LLC _# COMPANY NAME:bye C ti.ae,.,L ji 4'12p141491aRESS i 23 (iC`wet o rti, kJ• CITY rn�t5itpge_. STATE MA I?JP I oat,Ltei ITELI5©8'-,t77— ir- `6"•37 FAX[ I CELL 5f?$- •5D- EMAIL i 4 b ( . GG i p t,vice:-a--40 r& . c..z vvx $$$$ /7L 0 Lg/{ 140