HomeMy WebLinkAboutBLDG-16-002068 - I MAS (:H1.) ITS UN1rOY�1A. .YYLILAI IL)I[ rvnr,rL-rNir,,, ,._+ ,
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JOESIitt ADDP.E55- OWNERS NAME:
1 OWNER ADDRESS:. <4.A/l� TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RE5IDENTIAL�—
P� 1
CLEARLYNEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS 5U61v1i1 1 EU: YES❑ NO❑
I APPLIANCES, FLOOR-- I 5snt 1 1 2 3 1 1 5 1 5 1 7 8 1 9 1 10 111 12 13 I 14
IBOILER I I
• 1. BOOSTER I i I
I I I I I
1 CONVERSION BURNER I I I I I I I i 1
I COOK STOVE
I I I
I DIRECT VENT HEATER I i I I I I I I I
DRYER I I I I I I I I I
I FIREPLACE I I I I I I I I I _I
FRYOL14,TOR I i I i I I I I I I
FURNACE I I I I • I I I
I 1
GENERATOR I I I I I
I GRILLE I I ! I I I ! I I
INFRARED HEAD 1 I I I I 1 I I I
1 ( ORATORY COCK 1 I I I I I I 1 1
I MAKEUP AIR UNIT
1 OVEN
I POOL HEA l 1 I I .I I I I II I I
ROOM i SPACE HEATER 1 1 I I I I I I I
ROOF TOP UN T 1 I I ! I I ! I
TEST
I
1 UNIT HEATER 1 I I I i I ! !
UNMENIED ROOM REATER II I I
WATER HEAT ! ! I I I 1 ! 1 ' I 1
I I 1 1 1 1 1 1 1
I I 1 1 1 1 1 1 1
1 l 1 1 1 L 1 1 1 1
INSURANCE COVERAGE
I have a current liability insurance policy or i3 s-ubsian-iial equivalent which maze requirements of NIGL Ch.1-2 YE.2-
If you have checked YES,please indicate the type of coverage• c ecknag the appropri box beiow.
LIABILITY INSURANCE POLICY OTHER TYPE IlsoDdiNTIY ❑ BOND 0
OWNER'S INSURANCE WAIVER:I am aware trot the limns does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that ray signature on this permitapplicaton waives this requirement
CHECK ONE ONLY: OWNER❑ AGENT ❑ •
SIGNATURE OF CVJI iER OR AGENT
hereby cermy that all of tie details and iniormation 1 have submitted(or entered)regarding this application are tue and accurate to =best at my 1
Knowledge and that all plumbing work and installations performed under tie permit issued for this application will be in comp all Pertinent
provision of the IVIassachusets State Plumbing Code and Chapter 142 of the General Laws.
PLUMBEkIGASHl I NNNAlh4E SO) Di $14-VUrO d S SIG TORE
COMPANY RAN:- /4Vj —I&T 4.0 ADDRESS: 2 7 • eeD
CITY:
Afra^ STATE "14 ZIP: Q Zb 7 3 FAX:
ca _ tic O g _
MASTER OUP EYIV I _ II�IST." I 1-1 CORPORATION❑g PAi r i_P IT_ �y EP❑
_R if-
OCT 08 �
B ,0 4'= e:_ARTME v
By. ------ --
OUGI«GA
S fNSPICC'J,ION NO .IES �'II.1�51'AGJU 11OJ(.IN8J'1EC'J'OR USIA OJVLY FINAL J.I`l, OhI NO'1)
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ -- —
FEE: $ — PERMIT(I
,I',4AN a.11E1'J1C11'NO'1'AES ..— ----- — --