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31C-046 (13) 1 �! cL#ii 61-) '-Yeios- MASSACHUSET T S UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTINGIWO CITY: MA. DATE: / /- PERMIT#v t JOBSITEADDRESS:_ �!://may. ,�L/� �_ OWNER'S NAME: GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL PRINT ❑ EDUCATIONAL ❑ RESIDENTIAL ] CLEARLY NEW:10 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-. FLOOR-- Bsmt 1 2 3 4 5 6 BOILER 7 8 9 10 11 12 13 14 BOOSTER CONVERSION BURNER COOKSTOVE DIRECT VENT HEATER DRYER FIREPLACE f FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK T R MAKEUP AIR UNIT A OVEN POOL HEATER. ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE I have a current liainsurance policy or its substantial equivalent COVERAGE wh chmeets bility the requirements of MGL.Ch.142 YES ❑ NO If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 b ' c pli ce with all Pertinent provision of the Massachusetts State Plumbing/Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME:__ LICENSE# SIGNATURE COMPANY NAME: A el/. ADDRESS: CITY:��� '�,7�i.� ZIP:- /3 G —�� ��_ FAX: TEL: CELL:_y (- �)-A15 EMAIL: VASTERX JOURNEYMAN 0 LP INSTALLER❑ CORPORATION❑# PARTNERSHIP 11# LLC 0# W C) z z 0 H U W A4 d w a z� a� D WLUF= z 0 CL ui w �a a z a d � � U x N a = V H � O z z 0 w � N cn Q � � o � � i R CP*�//�617 A10-5- • `� MASSACHUSETTS UMIFORNI APPLICATION FO,R A PERMIT TO PERFORM GAS FITTING WORK CITY: t,-. i ,, MA. DATE: � //S�C PERMIT#F4' 'I& JOBSITE ADDRESS: te— OWNER'S NAME: OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:g RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-1 FLOOR–+ Bsmt 1 1 2 1 3 1 4 5 6 7 8 9 1 10 1 11 1 12 1 13 1 14 BOILER BOOSTER CONVERSION BURNER COOKSTOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE P UMBI G&G S IN4ECTO INFRARED HEATER N PTO LABORATORY COCK A FROVEP MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 co pli ace with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER/GASFITTER NAME: LICENSESIGNATURE COMPANY NAME: �.�5 ,���� /� 7 ADDRESS: -G J O � CITY: ,7`7� STATE: '�L l/-4 ZIP: z7/L9,5 C FAX: TEL: CELL: EMAIL: AASTERX JOURNEYMAN❑ LP INSTALLER❑ CORPORATION ❑# PARTNERSHIP❑# LLC❑# s� 0 QZ/o:5 MASSACHUSETTS UNIFORM APPLICATIONS FOR A PERMIT TO PERFORM GAS � � FIT#T�iNG �O(RyK CITY: L i MA. DATE: PEPMITr 577 JOBSITE ADDRESS: 3 G /,��y /�;/� _ OWNER'S NAME: OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL�] PRRi T' CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-1 FLOOR Bsmt 1 2 3 4 5 6 7 8 9 1 10 11 12 1 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR I PLIUMBINIG&GAS IN GRILLE I N RTHA PTO INFRARED HEATER AP ROVE LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 <nowledge and that all plumbing work and installations performed under the permit issued for this application will be�copli ce with all Pertinent Drovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' PLUMBER/GASFITTER NAME: �f�Z.'/ '��/7i�� LICENSE# SIGNATURE COMPANY NAME:� S ADDRESS: �� s�0 -,7 ,ITY: � <.;� '.�,7`7! STATE: l y/-4 ZIP: z7"D2 C FAX: -EL: CELL: ys� �( -���� EMAIL: .ASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION ❑# PARTNERSHIP 7# LLC 0# 112 tr:,.r!c J�� 411d5-- C� rrsr7 MASSACHUSETTS UNIFORM APPLICATIONS FOR A PERMIT TO PERFORM GAS FITTiNG 'W'OR°K CITY: L �a� ,� ./ MA. DATE: J���G PERMIT � -4 9� JOBSITEADDRESS: JS1 OWNER'S NAME: OWNERADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRIVY' CLEARLY NEW: RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOOR- BSmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE P1 1MARIN &GA INSP CTO GENERATOR I N RT PTON GRILLE A INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ If you have checked YES please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 co pli ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: `��/ti�� LICENSE# ` SIGNATURE COMPANY NAME:. —�5 >L���7 ADDRESS: s�0 CITY: '.� STATE: ZIP: z7/D FAX: TEL: CELL:y�-L-�( -�7�S EMAIL: IASTER)g JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# . : r� C���►Sid ajar a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFOPuM OAS F17TIlIG;VVORKa CITY: zlt r_. / /4./ MA. DATE: 11�5_11_ PERMIT JOBSITE ADDRESS: /- 5 LZXC5 c �� �� OWNER'S NAME: OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL )PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES? FLOOR Bsmt 1 J.,, 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 114 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR PLU BI GRILLE NO AM TON INFRARED HEATER NO APP OVE LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER. ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 <nowledge and that all plumbing work and installations performed under the permit issued for this application will be.in co pli ce with all Pertinent I Drovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /' P PLUMB ER/GAS FITTER NAME:_ � '/ 11'''-'' /7��� LICENSE# SIGNATURE ,OMPANYNAME:__ t2X1 le_144 ADDRESS: j O� :ITY: <., , STATE: "/ I/-4 ZIP: /7/v3-6 FAX: 'EL: CELL: EMAIL: ASTER,X JOURNEYMAN❑ LPINSTALLER❑ CORPORATION ❑# PARTNERSHIP 0# LLC❑# �2 e / leo A-" C , ,* 116 -7 MASSACHUSETTS UNIFORM APPLICATIONS FOP A PERMIT TO PERFORM GAS FITTING WORK /F CITY: L ia,, - / MA. DATE: �- /O`��� PERMITAe"t6f —57.Z JOBSITE ADD S: 3 G'/��5 c 117Z,11 /!y OWNER'S NAME: OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ]PREM T CLEARLY NEW: RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES? FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR P UMBI G&G SINq Fr. GRILLE PTO INFRARED HEATER TAP ROV D LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER. ROOM/SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ DWNER'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 ❑ AGENT ❑ )IGNATURE OF OWNER OR AGENT iereby 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 .nowledge and that all plumbing work and installations performed under the permit issued for this application will be.in co pli ace with all Pertinent rovision of the Massachusetts State Plumbing/Code and Chapter 142 of the General Laws. 'LUMBER/GASFITTER NAME: ' LICENSE SIGNATURE ;OMPANY NAME: �,/SADDRESS: :ITY:� STATE: '! f14 ZIP: z7 1,4 FAX: EL: EMAIL: 4S, TERP JOURNEYMAN 7 LP INSTALLER❑ CORPORATION ❑# PARTNERSHIP 0# LLC❑# 11 a G�S7" 171171 �Da�' C7710' 915� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ij`d Uv-. fJOBSITE TY ���? .✓ MA. DATE G�S�G PERM11 IT# f � I t♦ ADDRESS -7 3 l/�/ ,L ��� 02 /I, OWNER'S NAMEjr G✓��� OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL ElEDUCATIONAL ElRESIDENTIAL[ PRINT � NEW: CLEARLY ' RENOVATION:❑ REPLACEMENT: E] PLANS SUBMITTED: YES El NO ❑ 4 FIXTURES Z FLOOR-* BSMT 1 2 3 45 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK GAS NbPEYTUH LAVATORY ROOF DRAIN - SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch.142. Yes ❑ No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE OF INDEMNITY ❑ BOND ❑ 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. ❑ Signature of Owner or Owner's Agent CHECK ONE BOX ONLY: OWNER ❑ AGENT 1 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 perm. issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapt 4 f t eneral Laws. PLUMBER NAME / ,��U/ L�Q/¢ i4�— SIGNATURE LIC# MP JP❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME ADDRESS: X63 CITY ti STATE ZIP le5V EMAIL TEL CELL_ /�����7 FAX x 1. Q r c� C4 h � H 0 z h o H m = m � � D � H n � O r Cn Cy z � o r x m cn UD m O � � ❑m C7 c O z r ❑o K y z r z h H 0 z z 0 H h MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING V1/OR11 CITY L� « MA. DATE l /. PERMIT# JOBSITE ADDRESS 3 OWNER'S NAME C✓�� OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAVn PRINT NEW: CLEARLY RENOVATION: ❑ REPLACEMENT:E] PLANS SUBMITTED: YES ElNO [I FIXTURES 7 FLOOR BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER 1E1 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 7 LAVATORY I NOATHA PTON ROOF DRAIN E N TAPP OVE SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION / WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes ❑ No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE OF INDEMNITY ❑ BOND ❑ 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. ❑ Signature of Owner or Owner's Agent CHECK ONE BOX ONLY: OWNER ❑ 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 P inent provision of the Massachusetts State Plumbing Code and Chapt f General Laws. PLUMBER NAME !�l// �,P�' SIGNATURE LIC# MP E�r JP❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME / ADDRESS: CITY STATE,/J�_ ZIP A EMAIL TEL CELL���a7�/S� FAX I O ^\ r 1 v y T -1 m = r� D � � x n � � b O 1 r cn z � o N rn cn .� m D z -1 = rn z 0 O El CD O z r ❑o K r z b h n a 0 z z 0 y r� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY nn MA. DATE � �� PERMIT#1�1'- ���5�S JOBSITE ADDRESS OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT NEW: RENOVATION:E] REPLACEMENT:❑ CLEARLY / PLANS SUBMITTED: YES❑ NO ❑ FIXTURES-1 FLOOR-- BSMT 1 2 3 4 5 6 7 8 9 10 11 BA12 13 14 THTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER I.Uf 7i n, & ,AS If SPEC OR FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK r LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER NCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes No ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND 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. Signature of Owner or Owner's Agent CHECK ONE BOX ONLY: OWNER ❑ 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 of the General Laws. PLUMBER NAME /�Ci/ ( SIGNATURE LIC# MP JP❑ CORPORATION ❑# PARTNERSHIP ❑#_ LLC ❑# COMPANY NAME�/�iJ�S � y �G� ADDRESS: C 1 3 CITY STATE: ZIP '5EMAIL TEL CELL� � FAX Q � d x b GZ 0 z NJ 0 m = m U cn Dto � y Z r m O z m h 70 m C/)Ez ro m n z # -n 70 N U) ❑� O z ❑o r It a r z h a 0 z z 0 h t