HomeMy WebLinkAboutBLDG-19-003621 ? /9/°
puP FOR
A PERsvi I-1-TO PERFORM GAS FITTING WORK
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CITY I Town of yA(---r au ) i- t MA DATEJ > I.PERMIT# /')•/-0,klq."0090/
- JOBSITE ADDRESS 1,40____GLeAaaa_p_mr. ___ i OWN 'S E
ei 1-3F OWNER ADDRESS 1 . i imfr() )3‘7-47-1,';'. IFAXI ,
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TYPE OR 7.
OCCUPANCY TYPE COMMERCIAL t f- EDUCATIONAL I-1 RESIDENTIAL
PRINT ._
C EARLY NEW:n RENOVATION:LW REPLACEMENT:U PLANS SUBMITTED: YES'ID NO LI
APPLIANCES 1- FLOORS-+ BSM 1 1 2 3 4 1 5 6 7 8 9 10 11 ] 12 13 14 -
BOILER - - ..._.. -___t _ _f_____I ,t___11.____f_t I
BOOSTER L__t_il.,_
CONVERSION BURNER LI ii Ji —__i: —411 __f ' - --1 4 I
COOK STOVE - -
-_ _ 1
DIRECTVENT HEATER i_ AL IL i /I ,
DRYER I . !4 AM , _41.___Ac,„___-__4_______P VI V !I
FIREPLACE / _ _I':,: 3—1,L 1_.. A_..,A At t_i._,...,I _
FRYOLATOR I_J_ J__1! T1 .1-1.--41— —g- - lilt: •11111r ''' -
FURNACE 1 IIIMIIIIIFWiiIIIMIM __ - __', ___ _ E___
GENERATOR =li _i'_ , i•- ', , _ _ 111111111111.1111111i1M, _:-...:•,_,
GRIT I P 11/11111 _.---- 1____P____W -' = , - a z . .
INFRARED HEA I L.Ii i_ _,4_ L_ t______L____!i :• , •i '. R_______1 __§ _C___ _C____
LABORATORY COCKS 1 F .1-11.---1 _ .1 _ "----, we-bra:, - ' Pia" bin."' 0-6(_--'-.
MAKEUP AIR UNIT a- .n ;• so j a , CP.:- ,0.aaji
OVENki==101VMSOGIIIPMe•MOCIIMMI
POOL HEM EN ' 1= ---- -REIF - _-:` ' `' -•''i -?,Llat4_
ROOM I SPACE HEA I EN MUNI: IF" i " f_ _,11111t muirmiki_ awrint
ROOF TOP UNIT - ••• ---"-...milm--- Effi ,-— u-14:mimmirramix.
TEST MCI 7 ,11011-1M- ,' _ _ -.11.1.AllIlliVIMENINIUMI
UNIT HEATER / O. $ . _,. 47 i
uNvEmTED ROOM HEATER .-----1---1 _—__1 '._ ____ ' _____ . i........j • _ __ •, __: _ r _ 'imiewr
-WA!iR HEATER -- - -- _ ___j_J_ _t----L-r-,=-J_..-_-__-.-A-..._-_- _ i____4 _:Amilt
OTHER l ':— •i A ' - — -- -..---
rafaX-4Enbill1111111111111•111111FAMINIIIIIIIIK _ _• __-,. ,•_ _L___1111111111111111
' t.:LA;r-,:. C-044.1 'C- . T lii_MIU---: _ , . , Illwastim sr s!_
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INSURANCE COVERAGE
I have a current liabilftv insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES gN. 0
I F YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Rol OTHER TYPE INDEMNITY D . BOND Li
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 Ej AGENT n
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applicabon are true and accurate to pe best of my knowledge
and that all plumbing work and installafions performed under the permit issued for this appfi=tion will be in compliance ' li l'° " provision of the
Massachusetts Sta .Plumbing Code and Chapter 142 of The General Laws.
PLUMBER-GASFI I I ER t‘IAME e,u), irc-Bc.je_ _ !LICENSE:;'-_1_1 (A ' SIGNATURE
MP a MGF LI JP E JGF u LPG!f __i CORPORATION 619 8(7?'C.f PARTNERSHIP 034 (LiC J#L g
COMPANY NAME Mc•Sri ae., Ploni-k- 1-1 eLft . .-fic ADDRESS 1 1 _Cs-4 - • ° ik
CITY W. Vr-rfr.f)t.41,1 • STATE M ZIP a±3-C.--73 lila 56 k -77g- 55 I -
FAxtt5aymo-,-;7g61 cad 60 (,(1--37,9-411EMAILI k pnc piu nr\ b 6 C (rat , r.,(---
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