HomeMy WebLinkAboutBLDG-19-002822 M Pit , p P
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY �,�... .,.,r,•. a; ,„ . e ';1 .,:.v,w,,. ... .:.�,.] MA DATEE:Y.v , `//SJ PERMIT#/%I/)i- `/ (t 5
JOBSITE ADDRESS[i ,a,,G.Lif.4a .51k.k..,-.._:K...,.,.....y,_J OWNER'S NAME L,i.: .:3.'.lGs,....... ,fi .S_„ 'R.,,,:,,.:':-,!
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OWNER ADDRESS S h. ,�c TEI k i Liu:06 IFAX
TYPEO OCCUPANCY TYPE COMMERCIALS] EDUCATIONAL RESIDENTIALi,
CLEARLY NEW:(, I RENOVATION:0 REPLACEMENT:0v. PLANS SUBMITTED: YESEI NO f
APPLIANCES 1 FLOORS-' eStn IIIII 2 3 0 5 ION 7^J : 9 to 11 �
BOILER I ._. .I 17. I ,
BOOSTER . . _ i _ I[ I ,.I; ".l I
CONVERSION BURNER iJIl _ . ( . KIIIN ( j }COOK STOVE y.,? I
tiontim..:" „II
DIRECT VENT HEATER _ r� ._ i
DRYER � _ �` 1�� � . 1_
FIREPLACE '�� i . ;,,ICI iI ,::...
FRYOLATOR i= . .. II I
31111% .
FURNACE :.I 11 111. I f1f 1 1111 N i I `,I
GENERATOR I I __.i1fIi [i Ill- I 1 1 „(
GRILLE `117. I I INKI l I ;
INFRARED HEATER l ( I f C-- .7i iD
LABORATORY COCKS liNkk,:,,,,,„i.111NEMMli ,,, , ONINKIWIIIE,:•i: . 1, .'1,ail
POOL HEATER ,
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Iliii I. ,1'iI' -...,� J ( l l �__I
ROOF TOP UNIT
_TEST MN IIIIMMINIRINOMMIIIIIIIMINIIIM: _ _ •:_ [
UNIT HEATER Nil I a*W CI 111111.10.1.111 y
UNVENTED•• cif ] _ [ ..�I I( I
WATER WATR__ __ _ __ ( i �I OPE'
OTHER ....---
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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 U-NO EI
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [ 1-`,.. OTHER TYPE INDEMNITY [-T-] BOND I:K1
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 0 AGENT El
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the Malts and Information I have submitted or entered regarding this application are tripsInd acstitatgrto the best of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in com i nCe with aIJjPerlinenl provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /'y „v ,
PLUMBER-GASFITTER NAME .__,Al-,4„g , ,.,._,,., ,.,, u,,,.TJ LICENSE#P,WI ,"� ' ‘. SIGNATURE
MPp MGF 0 JP 0 JGF L,,•I LPGI El CORPORATION nil J PARTNERSHIP D#E: i LLC f`.10ice 11
COMPANY NAME: .•' "� Pitt " .. ADDRESS �'P' ti :n B&� ^1 �f �.' i•�, , .t.n V ;L, ,�,.� •
a I`, L .vJ ,; ti p,. _ - .:� � . , t.1
a:°L•a•�WGI'u•E P+'•.'. ••W�M](iV�i' .f+uivlJLvf.t ate[.'lYu V� ✓t'.Yn Nvx4 uY .��Twi..:s
CITY Efis ar� � .........- ,:. e,_ ___ STATE t�I ZiP r�> at '�"�t TEL 74::—
FAX 6-11. :q? 'J X"ELL 3.1:8. j. 1EMAILL a 4 .sgs k.g t.M ..4.0h .. sr,t.- ..5?-�a...a..d...y,.. ....,.,..,.<..._..._.....W..:_......,M J