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HomeMy WebLinkAboutBLDG-24-606 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -:=!I_ CITY : / 0/1[v MA DATE --- PERMIT# 1-Ot-2`i- 4'v4 JOBSITE ADDRESS°7q' Rf OL-1 ? ' (OWNER'S NAME : J) tl. v'1 R©�i"4'-c r7 1 G0 i GO e_`� 'L - r?vi �l�c'v3 _(:I I TEL _ FAX' I TYPE OR OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL .J RESIDENTIALJ; CLEARLY NEW:, J RENOVATION:1 REPLACEMENT:Adi PLANS SUBMITTED: YES 3 NOU APPLIANCES 7 FLOORS-+ _ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _..._1_J J_�_—J_—J_.____i J.__i___Li__I_____(_J 1_J BOOSTER ;—J—J- I, I t_J—J'__Li_J—i.—I . .I . ..1. . . J CONVERSION BURNER I_—(:_J I f f— J__J:.—J__J J_°_J!—J COOK STOVE ;_I . .r-J_J__.__t_ ,-j• J:_ _J'__J _J_1 DIRECT VENT HEATER __—__J .. l—J-__I_J_J—7.�1_1. -:Li ILL] ��_j: ...... DRYER• , J._.). L J..—J :—�•-1 .—J-1-1 ._. . ______I _____I • FIREPLACE —J . ! I t-J°_J-J—J� !__1_ J__[-J,:_-_.__IFRYOLATOR J !;_��—_J r_.._... _ 4 J ____ !L-1.__J __Li_J_J._!_1 FURNACE J J L--J. !—1'.—1 !—J ... 1 - .1 - . .._1__I GENERATOR l t.._ .—J _J _J_J —J—J_J_—J r GRILLE _� t. !_1 •_—J. i,J _�.—i • 1-,�:__J—1_____j INFRARED HEATER . __1 —rt_J,._J. 1 _�_—J'—J - . .I_.J —L—J.`—J--J-_J LABORATORY COCKS ( . -1._.—J_J:-.1 !____-!___J___J_I_J—J,J ! O ----MAKEUP AIR UNIT .. I_ `��_J_.__LiJ I_._._1—J,--J __ —J_._I G J:_ 1_ _. OVEN --"I_.._J I_ - -I -- I, J_._. I. I�J -1•__._!:LLD_I_.__( 1. 16 POOL HEATER —J_—J_J..—.J:Li!_J� :___J� —aL—J��_. __1_ I _J ROOM/SPACE HEATER _ _I J_J .. I__J IL I ..I__1__U_j I.______I-LL3 ROOF TOP UNIT —_,_I f_ r_J U I J—_J—_I`al_—J.—J—J_J-_____II _ TEST ____I.-1 f f 1. ;_ J._ _1 1 —1 3 J_- 1 I UNIT HEATER _ I_I:_-_I l i_"_.__I . (____.J_-1-__1__-_.( _Li: I_J UNVENTED ROOM HEATER . ,___J_J •I,. i f • I, !__I . I__1_L__J ___1 _____J J WATER HEATER... --_-----.--.--_J f . i__J_— 1,L_I 1__l _J_._J�J __Li_ J__1 OTHER = i—_J- , . _.I, . .-!"—_1 r 1—J_.______I_.______I�J_J_J.__-1'-1' _. .I I._!—J J_1_J__� J _J_U !_—J—J'�_J ! I—JU �r.J.J -1_JJ • I__J_-__=I-1-(J No I r I i I ICJ I J I .... ., ,..__!._" .I / ..•- f ~ INSURANCE COVERAGElb _ b I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ( O T 1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY j BOND I 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 ,-II AGENT Ut 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 permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _yam PLUMBER-GASFITTER NAME � nl S -6d/Ae _I LICENSE#;tf,Se- SIGNATUR MP: MGF:_J JP : JGF;2 LPGI—J. CORPORATION` #' 31 (PARTNERSHIP!.# I LLC:_(#{ I COMPANY NAME'//l/ cr/,/r r��/-/�1/e I ADDRESS: /rtQ{W, .5' — CITY ZIP41:/ A. ITEL 7747' 37 G,3y- f • • FAX CELL: f EMAIL' ,iLpd�1G��/�� ° ("G7dyi -------- •—..-I l YTE D. CP-fir 0 2R4 UUiLD'NG UEr'AR_.IiMENT