HomeMy WebLinkAboutBLDG-18-007257 /9/4) iof Ce/
‘a _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
C '. CITY down of !/A r/�D T # MA DATE i PERMIT#/�t9b Ii-eo72 67
'- r JOBSITE ADDRESS! 13 gL G;t7: L. 00Ck L , I OWNERS NAME r r,nn .I Y)o,�).(\
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OWNER ADDRESS 1 1E4?7d gi:,l- 5s i j. S`AXi�___ �
TYFE-OR
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OCCUPANCY TYPE COMMERCIAL% F�ICATIONAL[j RESIDEN'ilA1
CLEARLY RT.y NEW-• RENOVATION:11 REPLACEMENT: PLANSSUBMITTED; YESO NO 1_"
APPLIANCES 7. FLOORS-+ BSM 1 2 3 4 5 6 I 7 , 8 9 1D 11 12 13 14
BOILER
BOOSTER
BURNER
COOK S I1 _ . �� r ala
DIRECT.IIENTHEATER _._
DRYER -r-:` ' . • --� -- - —}' =r _ _'
FIREPLACE i` 1I q -1 --_ '----3-2:-
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FURNACE11 il"w•*.�_.w.a,. I-T+"•..niM.�rwtlK!- _ iJ - - :r 1���_�i'Sr+..-wWl �'--a+,i a -- �s�11i•4.}LsiAv..
• GENERATOR
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INFRARED HEAT' i r0 ---...�• .,,.�._._.�.. -. ini111101111 11 WW. -
LABORATORY COCKS • 11. E� !t:WA LL Lam.. �C y i "•�
MAKEUP AIR UNIT Y' — -•_ . i '.._� ` ' '- _ : _
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41„*
POOL HEATER • re. . : �-1 f _ ��
ROOM!SPACE HEATER - ' _ _- ta_
ROOF TOP UNIT - 1 �_ . '�'.'+.Ina min 11111ff:
TEST '._
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UNIT HEA I di _
UNVENTED ROOM HEATER t I, __ . - , WEI
WA►ER HEATER I_ _ _ ,...�.. �-- =
' OTHER : ` _ , _ `,' _- s
imuittankamolmilimikkour mpg auer
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INSURANCE COVERAGE '
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I have a current liability insurance policy ors substantial equivalent which meets the requirements of MGL Ch,142 Yt3 l._:NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW JUN p i
cd1UABILfIY INSURANCE POLICY OTHER TYPE INDEMNITY 0 - BOW 0
OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required b1F IN . ,
Massachusetts General Laws,and that my signature on this permit application waives this requirement L P
• CHECK ONE ONLY; OWNER D AGENT ri
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 accurate to the best of my knowledge
and that all plumbing work and installations performed under the permh issued for this appfcabon will be in compliance ' n c provision of the ,
Massachusetts Slate Phanhing Code and Chapter 142 of the General Laws-
PLUMBER-GASt-i I I ER NAME,k v;n in C-B(•/ P_ i LICENSE#'11( 0 SIGNATURE
MP MGF 0 JP 0 JGF 0 LPG CORPORATION d# a 8(:,. .C. PARTNERSHIP LLC j �
COMPANY.NAME ( ei ADDRESS 11 c 4 P.4J( . k
GTY 1 U. Ali rn+r L51
Ft 6)7go-67 STATE ZIP Q�(�7 3 TEL f5 5 ?7•FS- Q 55�
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