HomeMy WebLinkAboutBLDG-19-004224 V
1 MASSACHUSET T S UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FW1SIG WORK
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:E:ETREAADDDDRREEssss I I � a as rL�a�ii., j OWNER'S NAME 1_ rL .4:l(�__TYPE TEl �l
OR OCCUPANCY TYPE COMMERC AL'; rr
PRINT ED NAL RESIDENTIAL
CLEARLY NEW:0 RENOVATION:0 REPLACEMENTV .PLANS SUBMITTED: Y=Ruu.'' NOD
APPLIANCES I. FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER —,< _ -_—
BOOSTER L--__.._17._..__..�i_._..-!.1J_._.....�L. __:, al_-----i __It_
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CONVERSION BURNER ri -, �.__.
COOK STOVE i.__-1'--.,._._li 1- __mil 1^ _ !jr---,, ' i V i!! t---G_�t' _ l i
DIRECT VENT HEATER :—��� ___�_;II�-' ? _j. l ", - - )'
DRYER ._._ -' 1._ _ 1 :1„_�;
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FIREPLACE 1- >_____n------li i__—l'i_._1f _ -!-- 1----JF fi.- ' --__ — =—
FRYOR '___. l__P`__ -i ;___V _. r. , ___- ____A— _ 1
FURNACE =1_____1 = I . o - j f ? -- ti_
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GENERATOR
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GRILLE ii;_.__..-.111 Ji_ 1'1_ -9_ _` i-_-__s`i__ i ._ ql `'
INFRARED HEATER L__lh I I •'L__ '=Er_7.2i- �1. L ik,- - _ _' "._
LABORATORY COCKS --ir ~I I_._.._�5 .. It.,^ 1— +" rC____ — —: ii r :I:. _
MAKEUP AIR UNIT ..s _ 1 _�I .li._ . II... _.__. `1 _! it
OVEN 1-11._ L__-!'L.._...-,.1__ill if _.')._._.r._7 i— l` '1 fi'= 1
POOL HEATER i Li —''!_..__._...'I___ (- ?:77-77- 'i' h �- _ :, i.
ROOM I SPACE HEATER 1 _ '� i711- -I "r- r ii._— [- -
ROOF TOP UNIT ? —?I_-_.__f I I!L__.'j ram ^ >4 r .. 'r -•-•--!P��_ i
TEST f_ i E �l l__-.;1 ._ i__ ..~i.l.-_ jr—_____I __.....2 =i
UNIT HEATER _•',, 11 Or r—P` °t' - _ .... :1_
UNVENTED ROOM HEATER i ;l i.�__1 •
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WATER HEATER i_..Y'•i,,r_N;._ _4___.!IL _!-____i1 i:I_-1__ _' -n--.'lr_
OTHER I. ILL__- L___ C_-:L� 1L ;`_; - _17 ._.-. _,I_-. i__-- �ii• L
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LJ NO LI
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY F! OTHER TYPE INDEMNITY 31 BOND e._..1
OWNER'S INSURANCE WAIVER:lam aware that the licensee does not have the insurance coverage required by Chapter 142 o`the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
•
CHECK ONE ONLY: OWNER [ AGENT 1
SIGNATURE OF OWNER OR AGENT
t hereby certify that at 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 Frcvision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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PLUMBER-GASFITTER NAME j I.Crai Bishop
,...... .______ LICENSE#15101 J SIGNATURE
.._......._._...._.....,. ._._.._-................
MP 1; MGF JP JGF L LPGI J CORPORATION i 241, i.PARTNERSHIPi # ;;LLCj#I, ___,...._-.
COMPANY NAME:EH19h Efficiency P ADDRESS 378 route 130
CITY SandrArich / STATE Ma /ZIP;02563
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F EMAILiadmin high-efficiencyllc.com .._
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