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HomeMy WebLinkAboutBLDG-119-007071 .�. _ MASSACHUSE I I S UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ;Town of V pY-)(1 `_ , O6 /P-007071 MA DATE; 1 iPERMIT# JOBSITEADDRESS + / �� MO,1 '�- - . OWNER'S NAME i_ei n d., V1':n_ 00*v r i • . G. OWNER ADDRESS I i TEl o 6)ag0- g g S I, IFAX1 TYPE OR OCCUPANCY TYPE COMMERCIA.LU D'1CAT1ONAL I RESIDENTIAL' PRE r-r.RARLY NEW:jj RENOVATION:U REPLACEMENT:] PLANS SUBMITTED: YES0 NO APPLIANCES 1. FLOORS BSM j 2 3 4 I 5 6 I 7 5 I 9 10 I 11 12 13 [ 14 BOILER _ l , i i. f . _ _ 1 a BOOS I tftt. ;4t .. + 1 ' — •-_._: i o CONVERSION BURNER ' �� - -:7 ii - _ _ _ GOOK STOVE k _. k- k' - .. _- -fi- -_ -_- •__ y. . _4t ,.. r-. DIRECTT.VENT HEATER __ -. ;,_ L___ DRYER ?I a 1— _-r..1 V--.- --•`- FIREPLACE _ _ r FRYOLATOR ;;—.J ;-0 r- i—._.. - ; 1 FURNACE � _1 . _ -I • GENERATOR :, • J. i GRILLE t - i` " ' . w:t - •_. :1� 2�J $+-! F INFRARED HEA I EH W�y _ - �' I MIIIIIEM'_LABORATORY COCKS , ., e- ' ' • 0 Mir- MAKEUP AIR UNIT _ -Mi _ _ p- I -is,�,iuy -;•.n r:• 59 ' C 12,t 'n - T. POOL HEATER - Iona iW� t ',1IJltL'�.;�lL.t� ROOM 1 SPACE HEATER > f_ I .44•i: 'lam +mot ROOF TOP UNIT A - ' ,_, •�, a� TEST ■i'� [L■ [ ice- �' il■■�€t UNIT HEATER Its '� J l U , . - • WA a' _ .--a m�.+r w � 11 i.` ii> , OTHw• fit ` Bu rr urNd DE_ T INSURANCE COVERAGE - - ~ I have a `ri a po icy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESO 0 1)F YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW , LIABILITY INSURANCE POUCY M OTHER TYPE INDEMNITY D . BOND LI OWNER'S INSURANCE WAIVER:lam 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 D AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicafon are tare and accurate tope best of my knowledge and that all plumbing work and installations performed under the permit issued for this application mll be in compliance n �' provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASH i I Lit NAME j 7 v iYJ 4(.. ,), _ i LICENSE# 1 I b 0: - -- - SIGNATURE MP a MGF0 JP 0 JGFD LPGI0, CORPORATION Lo#1,9 80 G I PARTNERSHIP _ R LC — COMPANY NAME r! c-sr;c B PivNt 4- � S/tc- ADDRESS 1 I J1 J P0•1 i - i I ���_ psi t CITY W. `/�,�rnr>c.-1 STATE ZIP, 4�673 TEL ak�j T • 55� - Fr+xE° a }7�0-G7K5i CELL!5ok 364?,7a4 EMAILI k, p t� 6 � rm. Ilia s-f , o e,