HomeMy WebLinkAboutBLDG-18-000293 itiASSACHUSt i i S ON:FOR11 APPLICATION FOR A PERIITIET TO PERFORMF.711\16 111WOR
197 ern't' ,M.-Ll/4 [: IAA. DATE � PERMIT.7 r' T./' V / -CaC `'9
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JOBSI t EADDRESS ;. -0 C^-. AJ L4e ,4 / 1 OWNER'S it!A,SriE' a' a' (I/r'l'/ 11
s OWNER ADDRESS: Si g 4,4../0 4(-S, ,11. (sr," 1,2 C l ►'F-1 L p-44 .-6 YSC-c -2 FAX'sue t
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C ,r Nat 0 REh!OVAT IQr1:1 i R,t`FI.F`,GE LENT:0i PLANS SUBl ift i tU: YES 0 ND -
FIXII T RED I FLOOR— I asrn= 1 `I 2 1 3 1- 4 5 1 D 1 T 8 9 90 1 i 1 12 1 13 1 1'
r3OIL_' { i 1 /r;�� il-�" .- Grin ]` I I I I
BOOSTER i E I 1 - 1 I {
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0( I 1=EC EN HEATER _ -1 i
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I have a cunt Hawaii:insurance p-;,licy o:ils stusi—t ritla€equtualan which meet,-the, rrs,:It of PAU_Ch.i'Z YES G40 0
If you liaus chocked i ESL.pi s indtca:the type o;Coii& na by checking the approp`late 1Di'?e1D J.
LIAEILr'_`'Ir IuISU• A:tiCE PCP C T 0— DINER TYPE INDEMNITY Li BOND 0 - ti.
OWNER'S f NE RANCE tillARJER:I am aware e that the licenser-dc-s nog Math,;the iriai!railGe coverage required by Chaps 142°stile- - -
MassachlSC-tt Gena;ai aws.and Lhai.my-signanne Oil this pa-mit applica}{tr waives this requirement. _
CHECK ONE ONL,r: OWNER 0 AGE?f T 0
SIGNATURE OF OWNER OR AGENT .
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hereby certify that all of llie details and information I have submitted(or entered)regarding This application are True and accurate to the best of m,
Knowledge and that aII plumbing taw 2orl Installations performed under the permit Issued for this application will be in compliance with all Ferment
provision of the Rfiaasachuse State Plumbing Coda and ChaDier 142 of the General Laws. A
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PLUWEIGASC111 tli NAME: 1/1441/7 Cf-?;V t;ilc'G8/L47;4 LICE ?SE L, 97 ( IGt [UP.E y
ADDRESS: �s I :�t/0r7 I
COMPANY NikiVIE 3 6:_`5' �rr/vi 6iJvr_U 7%•��iriv' ]: DDRESS:,clrr ,�1.=r _ --
-ter. ` ..f #cSl!�fC l_� ZIP: 0`?�j��/ y FAX: p:7`�ir V.�`_
CITY. _/,.f�171/f __r1'
TEELvr-_77 =J�'`%S I o7o EAEMAIL: _r'�'/v 0 j�S,9/v__ ._—h. ,_zJC�✓
MASTER l 1OUFINETriAN 0 LP INSTAL,. 0 coRPoRATION-J#) QJP t NERSHIP 0 gt_, I LLC 0 i J7?I "
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