HomeMy WebLinkAboutBLDG-19-005926 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK •
ili CITY I 1 r-a i� t , ,, MA DATE ,4Qlla j PERMIT#fr-/- 7' .fI aP
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OT OCCUPANCY TYPE COMMERCIAL 1_.1 EDUCATIONAL RESIDENTIAL ,71
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CLEARLY NEW:0 RENOVATION:V REPLACEMENT:I I PLANS SUBMITTED: YES f;,, l Na[:
APPLIANCES 1 FLOORS--* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
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BOILER ! 1G t I _._ _-- __..._ _- -- . _
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CONVERSION BURNER r ,_.;L_: it ,f 1r, r. L_ .._._1.-=,.,i , I._:..:_�.I`:_ .`�,,.II "f r,-- E
COOK STOVE f �L I2� ;I I J I 3 f 1 I [ [ [ : I '' `I
DIRECT VENT HEATER I r I 11 ;L r ,:,.- ,r .-i f rl ,� �i r i. 1 C-�.a
DRYER i i L 1 __..:. ,—. . _ il if 71, _
FIREPLACE
FRYOLATOR l._, f ar. _.._s11 jr7 7Jr.7211 3 it �( 1 i GL
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INFRARED HEATER 1.M f.__ ,�3L .,I1 i1._.- .-.'(. _ _ =r 'I�. .., i `lam ,r._.�:L r_ , (, .ir_:�..s 1
LABORATORY COCKS _, :._._ - _ -
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POOL HEATER __ _
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ROOM 1 SPACE HEATER r -'`I.. . : f -IF,_�_f( ,,-.J f.<_.. I , r 1_, i i i ( If €(-. r
ROOF TOP UNIT 71 .,_. A`
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UNVENTED ROOM HEATER -.
WATER HEATER ._ .......,,..__�._r .......1....,-...,._.(- _,t 1_..�. r..,,.. 1 r --- !` if
OTHER I r._- (.. . aI- v..._... _-,...ir..__. lr.._� iI ;I l_ I. - fir..,: r i tC 71I�:ry
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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 (.60 1._-_4 ,
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1" r. ,I
OTHER TYPE INDEMNITY _. BOND El
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
1 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 rot/ on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Spencer Hallett 1 LICENSE#16224
MP IA MGF[.y1 JP[J JGF I I LPGI r.>I CORPORATION tor------]
�_ # 3834 1 PARTNERSHIP r„�#� LLC I
COMPANY NAME:�Spencer lle Hatt Piumbin9 and Heating,Inc j ADDRESS r 1 Old Falmouth Rd Unit 36
CITY Marstons Mills 1 STATEi Mai ZIP 02648 — 'TEL 508-428-6080- 1
FAX[5-0-8--4-2-8--7-9-9-1 1 CELL EMAIL spencer halletiplumbin com
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