HomeMy WebLinkAboutBLDG-19-002552 AMP: PA• Rc,
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
4' I —M 1w �..�t" G �� C PERMIT# �`I`�� t� -2
•�:_ CITY t•,TA)�� `f/' !'� MA OATS / •, (
JOBSITE ADDRESS . l f=► .r?.. -1 t ; Ai,i� t►":�„)OWNER'S NAME L i.�,�,,✓jam l ►'{s.,...-t J
G OWNER ADDRESS S ...oi- -L s��.r�.�...
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TYPE
OCCUPANCY TYPE COMMERCIAL'" EDUCATIONAL[ RESIDENTIAL
RINT
CLEARLY NEW: ] RENOVATION:0 REPLACEMENT:IZA''"-- PLANS SUBMITTED: YES[1 NOL I
APPLIANCES 1 FLOORS-1 BSM 1 2 3 4 5 ' 6 7 8 9 10 11 12 13 14
BOILER '-- 1, 1. i— 1 1 Cv J• Ir �f ' x
BOOSTER ( _! I" f-_Z 1 ,11 T (; �si' I �:.ir .!
CONVERSION BURNER 1 I II _t tI. — L'.1 1 I :I , r `i 7 (i I' _ I r L•
COOK STOVE : z 1 1, l lf_ I � 1 I i I 1 1 t l if 1
DIRECT VENT HEATER I[ _ 1E c 11, P... J l 1 1 �1 i 07 f 1 1
DRYER C .I J I 1 I. 1( 1I 1I I
FIREPLACE ,_.„ I 1+ t ,
� w( � � 1 I 1 J ,I,� „I1 J
FRYOLATOR E .. ,,g.) 1[ 1'-- J 1; ,,�.I( i[ (— 1.. J f I♦+ Y' I I 1
FURNACE_,. _`- II lfh i tl ..If _— ...__1r- 11— [ -1 Jr-1
GENERATOR l, f J; I tr
GRILLE - J ,.zz71 r ..IJ 1,, ,..'Xs r` ,s , I I„.,,,..1 r 1a : it II I
INFRARED HEATERA
.a,._� �__._.._ Ir /f ��J 1 _I+ r �.I :s Imo,;=ri J( s .1 1
MAKEUP AIR UNTORY OCKS � , ll l l 1 _ _ .:..:::!.!,-ifs:.._ �._::: (_.�.:..C-4� ._: :r �I J 1 tlr_ ( ..I
OVEN ,._�u��I� 1I -s Jr�x I (� 11�: _II s .n. ) 1K K ter-��� _LIB ��
POOL HEATER r 11 $ 1 L .J . f ! f.
.� L i . .t -_+ .5�. - k -� ..1.7 _-i l..u_o °: Jiifiir. ''= io.0...- y Yr`a.
ROOM!SPACE HEATER 1 I(� !, _Jrf�+! 1 f I t I I 1 _ I .I! _1
ROOF TOP UNIT J I z ir�I 1 TEST
I id 1f r
i
UNIT HEATER IY I I �JI..,_:�1;_. ( .�i` 11 .,.z_. f f J I i!a 1' 1 I 1
UNVENTED ROOM HEATER 11 t�N T�l
_ � Ir I � � i tl I It .II. tT . 1
' WATER NEATER ` _ II,. .._I — ..!� i t . 1 I, J I �4
OTHER __ (i (� lr ] t '� fly II I'1 �! id 1f I al 1
r� ►a �( i f I
I� i t' r x it T 11 �' ( ! 1 t73 1/ li 1_ J _ 1 t' �f j�
hI _,` IL.L.. . 1 I( ....:117.7„1r_. ., 11.. .... .I. .. , ... I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL,Ch.142 YES El NO`Cj
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [,JJ--r OTHER TYPE INDEMNITY E, BOND 0 I
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 El
SIGNATURE OF OWNER OR AGENT
I hereby certify',cat all of the details and Information I have submitted or entered regarding this application are true'end acceurate'to the best of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be In con>{ili nde with alytPertlnent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (,"/q' / r ��_
PLUMBER GASFITTER NAME LICENSE#[,;a ap't�' I SIGNATURE
MP t4 MGF L; J JP Li JGF Li LPG' i CORPORATION ?� � i PARTNERSHIP(y�#L�.o �r .]LLC .1#L_.
COMPANY NAME:r 9,, ij,/, 'ti�2� /� ..jADDRESS�Fr ,?�d°3.1ijikt,19._ _ .. t •�i-ii�--+'
CITY I c;'c�� i, e , ,,u�, STATE`t�'4'ZIPLr� ]TEI• n �. 1
FAX C a CELL,_ ��EMAIL� ,._. .. ..—.�:.,...�
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