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Gas Boiler Permits MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ulf CITY i NORTHAMPTON _j MA DATE 12/03/18 PERMIT# & 1"w` JOBSITE ADDRESS MEADOWBROOK APTS., BLDG#�, OWNER'S NAME ABCD GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:( PLANS SUBMITTED: YES;— NO APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 _ BOOSTER CONVERSION BURNER COOK STOVE !� DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 4 ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER P Uri UNVENTED ROOM HEATER N RT PTON -WATER HEATER APPROV D NOT - OTHER"I .__ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU 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 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,off the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 „ G `��=�. Sf _— _ - / PLUMBER-GASFITTER NAMEClifton B Kelley LICENSE# 12087TSIGNATURE MP�_' MGF❑ JP❑ JGF LPGI I❑ CORPORATION Q#[2078= PARTNERSHIP❑#1-- LLC❑# COMPANY NAME:General Mechanical Contractors ADDRESS 29A Sword Street CITY [Auburn STATE MA ZIP 01501 TEL,508-754-7366 FAX 508-756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com l L -0 rZ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: E PERMIT# ��- PLAN REVIEW NOTES WIW-1 - od1/5(-1C/ 14//U, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK l CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# a�OWNER'S NAME ABCD OWNER ADDRESS . TEL IFAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES L N0 APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER t BOOSTER CONVERSION BURNER COOK STOVE — �'. I 'C, ;, DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR _ GRILLE INFRARED HEATER _ LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST ;! UNIT HEATER UNVENTED ROOM HEATER WATER HEATER ,w OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ I IF YOU 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 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. PLUMBER GASFITTER NAME jClifton B Kelley LICENSE#[12087 SIGNATURE MP , MGF' JP ' JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIP❑#[LLC❑# COMPANY NAME:,General Mechanical Contractors ,�ADDRESS 129A.Sword Street CITY Auburn —� STATE i__MA ZIP 01501 TEL 508-754-7366 FAX F508-756-6750 CELL 508-685-8924EMAILjen@� generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ L Z f i4� Ct V FEE: $ PERMIT# PLAN REVIEW NOTES v I 1. `1 d JLIY -1 /v MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY NORTHAMPTON MA DATE 12103118 PERMIT# C019 JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# — OWNER'S NAME JABCD GOWNER ADDRESS TEL' FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:O RENOVATION: REPLACEMENT: PLANSSUBMITTED: YESD NO❑ APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER t BOOSTER _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER & 7 DRYER I T077FA- A PT 0 N' FIREPLACE `J - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT - TEST — — UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _ OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO [ I IF YOU 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 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. JL n PLUMBER-GASFITTER NAME ICllfton B Kelley LICENSE# 12087. SIGNATURE MP MGF® JP h JGF LPGI CORPORATION Q# 2078 PARTNERSHIP❑#0 LLC❑# COMPANY NAME:General Mechanical Contractors ADDRESS'29A Sword Street CITY Auburn STATE MA 01501 TEL 508-754-7366 FAX 150r 8-756-6750 CELL'50I 8-685-8924 EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Z 7i /9 `7"11 FEE: $ PERMIT# � / "r/sT PLAN REVIEW NOTES l/1%W'L - -To(t)w W/V -CN- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY "NORTHAMPTON « MA DATE 12103118 PERMIT# CJQ P—t0(—QbZ JOBSITE ADDRESS MEADOWBROOK APTS., BLDG OWNER'S NAME IABCD GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:[J. REPLACEMENT: PLANS SUBMITTED: YES L NOj APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE �. GENERATOR GRILLE _ INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST F LUN13!NC, UNIT HEATER NO ,A,"]PTO UNVENTED ROOM HEATER FP R 12,`J E NOT AP EEM)VFD— WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU 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 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. rn PLUMBER-GASFITTER NAME Clifton B Kelley __.. LICENSE#2087 SIGNATURE MP MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIP! # LLC❑# COMPANY NAME:General Mechanical Contractors ADDRESS 29A Sword Street CITY Auburn STATE MAZIP 101501 `TEL j508-754-7366 M.�. I FAX 5081 756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ n FEE: $ PERMIT# L 7i 1 PLAN REVIEW NOTES /��.b .G'�li6C•QS 1d /h�-IiSt' L P / MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK q ug .CITY NORTHAMPTON MA DATE 12103118 PERMIT# "r t^ S 1 JOBSITE ADDRESS MEADOWBROOK APTS.,BLDG# OWNER'S NAME jABCD GOWNER ADDRESS TE FAX L TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL i RESIDENTIAL' PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:,_j PLANS SUBMITTED: YES[] NO❑ APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER r CONVERSION BURNER COOK STOVE L _ DIRECT VENT HEATER DRYER -- --- -- FIREPLACE _2.EaDVED FRYOLATOR _ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER i ROOM/SPACE HEATER ROOF TOP UNIT —' TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU 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 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. __ - -. PLUMBER-GASFITTER NAME;Clifton B Kelley LICENSE#,12087 SIGNATURE MPF--1 MGF j❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078j PARTNERSHIP❑#0 LLC❑# COMPANY NAME:General Mechanical Contractors I ADDRESS 129A Sword Street CITY jAuburn STATE MA ZIP 01501TEL 508-754-7366 FAX'501 8-756-6750 CELL 508-685-8924 j EMAIL Ijen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �j,6�.1,1,C1 /i�►�?/ai2S' � FEE: $ PERMIT# PLAN REVIEW NOTES a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS.,BLDG# I OWNER'S NAME IABCD GOWNER ADDRESS TEL M 1FAx TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL[ EDUCATIONAL ( RESIDENTIAL❑ � CLEARLY NEW:[j RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOL] APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 _ BOOSTER + CONVERSION BURNER r COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR _ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT J4'4- OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT rI Pi rnwg Gns trp�ctla TEST UNIT HEATER FLUM INGZGASINSPECTOR UNVENTED ROOM HEATER TON WATER HEATER VE NOT MIPROVED OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L,_NO ❑ I IF YOU 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 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. 1 / PLUMB ER-GAS FITTER NAME(Clifton B Kelley LICENSE# 12087 SIGNATURE MP[:-1 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIP❑# LLC❑# COMPANY NAME:General Mechanical Contractors ADDRESS 129A Sword Street CITY Auburn STATE MA ZIP 01501 TEL 508-754-7366 FAX 508-756-6750 CELL 508-685-8924 EMAILLen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Z FEE: $ PERMIT# �t7lie772e?PM EW NOTES M 77 .s ii !tf is r :n r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 6 n CITY NORTHAMPTON MA DATE,12/03/18 PERMIT# VC ��w1`a'570 JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# OWNERS NAME 'ABCD GOWNER ADDRESS _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:[j PLANS SUBMITTED: YES❑ NO❑ APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE _ FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT _ OVEN _ POOL HEATER _ ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER INO Ml31 G &',GAS-INS , CT R UNVENTED ROOM HEATER TtiATOPT, N WATER HEATER / AF-1 F Q V FD NG R-aV D OTHER INSURANCE COVERAGE I have a current liabilily insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO ❑ I IF YOU 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 �r... 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. _.. -- --P dYA .8 PLUMBER-GASFITTER NAME;Clifton B Kelley LICENSE# 12087 SIGNATURpr 0 MP � MGF�w . JP L JGF LPGI CORPORATION❑# 2078 PARTNERSHIP❑# LLC[J# COMPANY NAME:'General Mechanical Contractors ADDRESS 129A Sword Street CITY Auburn STATE MA�JZIP 01501 TEL 508-754-7366 FAX 1508-756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLI' FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# f 6 PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY NORTHAMPTON MA DATE 12103118 PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# OWNER'S NAME ABCD GOWNER ADDRESS TEL( FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL;_ PRINT CLEARLY NEW:Q RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESNO APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER -_ FIREPLACE iJrwl ;( PEG p FRYOLATOR --X-()R1HAN'2TQN FURNACE r q pE; GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATERe OTHER _ _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO ❑ I IF YOU 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 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. Q /� PLUMBER-GASFITTER NAME Clifton B Kelley LICENSE# 12087 SIGNATURE �— MPIMGF JP` JGF LPGI CORPORATION❑#(2078 PARTNERSHIP❑#F— LLC[J# COMPANY NAME:'General Mechanical Contractors ADDRESS 29A Sword Street CITY 6bum STATE[. MA ZIP 01501 - TEL 508-7547366 FAX 1508-756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: E PERMIT# PLAN REVIEW NOTES 4-SLE P I 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS //FITTING WORK .y CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# /7/— OWNER'S NAME ABCD GOWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:. REPLACEMENT:r_ PLANS SUBMITTED: YES❑ NOr APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER r COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR r– FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS I— MAKEUP AIR UNIT OVEN — POOL HEATER e;C, um ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER & ASINSPECTOR UNVENTED ROOM HEATER ( JH;APTO WATER HEATER NOTAPPROVED OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU 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 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. Cl PLUMBER-GASFITTER NAME(Clifton B Kelley � �LICENSE# 12087 SIGNATURE MP j MGF' JP: JGF LPGI CORPORATION Q# 2078 PARTNERSHIP❑#F-- LLCE]#j 11 COMPANY NAME:'General Mechanical Contractors ADDRESS,29A Sword Street CITY Auburn STATE MA ZIP 01501 TEL 508-754-7366 FAX 508-756-6750 CELL 508-685-8924 EMAIL Fije�generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �z / � Ce-7- otav i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTHAMPTON MA DATE 12103118 PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# OWNER'S NAME '.ABCD GOWNER ADDRESS - TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES E. NO_—I APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER '' �`� ��-' ROOF TOP UNIT r— TEST UNIT HEATERI UI�1 _,� J pE UNVENTED ROOM HEATER TO WATER HEATER / PPP;)VEO NOT A _ OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , OTHER TYPE INDEMNITY , BOND l 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 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. PLUMBER-GASFITTER NAME iCllfton B Kelley _ - LICENSE# 12087 �� SIGNATURE MP MGF[_._ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIP[j# LLC❑# COMPANY NAME:LGeneral Mechanical Contractors ADDRESS 129A Sword Street CITY Auburn STATE MA ZIPi01501TEL 508-754-7366 FAX 5087756-6750 CELL 508-685-8924 JEMAIL lFqq_@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES ' ' ( 'ad MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTHAMPTON MA DATE,12/03/18 PERMIT# CQ(3 JOBSITE ADDRESS MEADOWBROOK APTS.,BLDG# OWNER'S NAME ABCD GOWNER ADDRESS _ TEL — FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL' PRINT CLEARLY NEW: . RENOVATION:: REPLACEMENT:v... PLANS SUBMITTED: YES ._. N0:_.. APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 - BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER Fi ROOM/SPACE HEATER -" ROOF TOP UNIT — TESTGA Ptlom�f ilb;114 1107 el i C. R-- - -- - UNIT HEATEROmTm ?Fp ori UNVENTED ROOM HEATER `` WATER HEATER.._. / OTHER ar E I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ 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 AGENT 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. lz %I._ , PLUMBER-GASFITTER NAME Clifton B Kelley LICENSE# 12087 SIGNATURE MP!. MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIP❑#F-- LLC❑# COMPANY NAME:!General Mechanical Contractors ADDRESS 29A Sword Street CITY Auburn STATE L��MA ZIP 501 TEL 508-754-7366 FAX 508-756-6750 j CELL 508-685-8924 EMAIL 'en eneralinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# a OWNER'S NAME JABCD GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:[' RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOORS— BSM 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 f GENERATOR GRILLE INFRARED HEATER I LABORATORY COCKS r" MAKEUP AIR UNIT _ OVEN POOL HEATER ROOM/SPACE HEATER i ROOF TOP UNIT TEST UNIT HEATER -1 UNVENTED ROOM HEATER WATER HEATER f - r OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , OTHER TYPE INDEMNITY i 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 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. PLUMBER-GASFITTER NAME,Cllfton B KelleyLICENSE# 12087 SIGN TURE MP MGF JP ' JGF❑ LPGI CORPORATION Q#0078 PARTNERSHIP❑#0 LLC❑# COMPANY NAME: General Mechanical Contractors—1 ADDRESS 29A Sword Street CITY burn STATE MA ZIP 01501TEL 508-754-7366 FAX05 8-756-6750 -1 CELL SI 08.685-8924 EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e CITY NORTHAMPTON MA DATE 12103118 PERMIT# CSL r P-aLI9 JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# a OWNER'S NAME ABCD GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL; PRINT CLEARLY NEW:I RENOVATION: ,.. REPLACEMENT:! PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ri BOOSTER CONVERSION BURNER _ COOK STOVE r— DIRECT VENT HEATERi-� DRYER _ FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER ` T UNVENTED ROOM HEATER E WATER HEATERU t7 OTHER ' �r. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU 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 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. PLUMBER-GASFITTER NAME`Clifton B Kelley LICENSE# 12087 S GNATURE MP! ,� MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIP❑#j LLC❑# COMPANY NAME:General Mechanical Contractors ADDRESS 129A Sword Street CITY Auburn STATE MA ZIP,01501 TEL 508-754-7366 FAX 508-756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com ROL:Gll GAS INSPECTION NOTES 1'II1S PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 100, Z / f7�SCA 41 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - , CITY NORTHAMPTON MA DATE:12103118 _--J PERMIT# JOBSITE ADDRESS MEADOWBROOK APTS., BLDG#_ OWNER'S NAME JABCD GOWNER ADDRESS _j TEL — FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES L!� NOD APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 _ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE _ GENERATOR _ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT , OVEN - POOLHEATER ROOM/SPACE HEATER +' ROOF TOP UNIT ` TEST IN IN UNIT HEATER f T'Ib FAP UNVENTED ROOM HEATER - ---= -" ;Q - i�lr AP WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ I IF YOU 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 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 comiance with all Pertinent f the plprovision o Massachusetts State Plumbing Code and Chapter 142 of the General Laws. n I A / PLUMBER-GASFITTER NAME[Clifton B Kelley__ LICENSE# l2087 SIG ATURE MP['_> MGF[D JP❑ JGF❑ LPGI❑ CORPORATION Q# 2078 PARTNERSHIPE]# LLC❑# COMPANY NAMEI eneral Mechanical Contractors ADDRESS 129A Sword Street CITY Auburn STATE MA ZIP ;01501 TEL 508-754-7366 FAX 508-756-675T]CELL 508-685-8924 j EMAIL 'en eneralinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY' FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES . 2-3W MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTHAMPTON MA DATE 12103118 —�PERMIT# — -- JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# �]OWNER'S NAME ABCI� D - OWNER ADDRESS TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL RESIDENTIAL❑ PRINT CLEARLY i NEW:`� RENOVATION:� REPLACEMENT: PLANS SUBMITTED: YES❑ NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER L CONVERSION BURNER COOK STOVE r..., DIRECT VENT HEATER E DRYER — FIREPLACE FRYOLATOR i FURNACE GENERATOR i GRILLE - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT -` OVEN POOL HEATER ' ROOM I SPACE HEATERLL- ROOF TOP UNIT _ TEST _ UNIT HEATER -- UNVENTED ROOM HEATER v G IN PE U WATER HEATER AN]P OPV - OTHER R ED ti Pi INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU 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 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. 1 PLUMBER-GASFITTER NAME(Clifton B Kelley LICENSE# 12087 SI NATURE MP - MGF❑ JP❑ JGF F-j LPGI❑ CORPORATION Q# 2078 PARTNERSHIP❑#F LLC❑# COMPANY NAME:Ge ern al Mechanical Contractors ADDRESS 29A Sword Street CITY (Auburn STATE, MA ZIP 01501 TEL 508-754-7366 FAX 508-756-6750 CELL 508-685-8924 y EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES ��� 9 .v, L Yd'6ca //Q. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# 'a JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# C�117 OWNER'S NAME ABCD GOWNERADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:, PLANS SUBMITTED: YES❑ NO[] APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER =�r— FIREPLACE FRYOLATOR FURNACE '— GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS - MAKEUP AIR UNIT i OVEN POOL HEATER - ROOM/SPACE HEATER ROOF TOP UNIT —firs '�' TEST -- UNIT HEATER t UNVENTED ROOM HEATER - PT WATER HEATER I— -, �!� OT ikPIPPIPM OTHERS INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO ❑ I IF YOU 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 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. PLUMBER-GASFITTER NAME Clifton B Kelley LICENSE# 12087 SIGNATURE MP v MGF❑ JP❑ JGF❑ LPGI CORPORATION Q#F2078PARTNERSHIP❑#0 LLC❑# COMPANY NAME:J General Mechanical Contractors l ADDRESS�29A Sword Street CITY Auburn STATE'` MA ZIP 01501 TEL 508-754-7366 FAX i508-756-6750 n CELL 508-685-8924 ]EMAIL 'en@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ 0 Of' Q FEE: a PERMIT# `� PLAN REVIEW NOTES l.//%-Z(/1�--- `1 dt J(-.P //U.VI-1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS //FITTING WORK CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# l SL f`' `� ' S JOBSITE ADDRESS MEADOWBROOK APTS., BLDG# OWNER'S NAME JABCD GOWNER ADDRESS ' TEL _ - FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL` EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW, RENOVATION:'. REPLACEMENT: PLANS SUBMITTED: YES; NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER t BOOSTER CONVERSION BURNER COOK STOVE u DIRECT VENT HEATER F' R�. DRYER A PP VF'ra. I" FIREPLACE FRYOLATOR FURNACE F GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS " 1 MAKEUP AIR UNIT OVEN POOL HEATER ALL— ROOM/SPACE HEATER - � ROOF TOP UNIT _ TEST r i UNIT HEATER UNVENTED ROOM HEATER N WATER HEATER / OTHER , INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY I 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 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. Y PLUMBER-GASFITTER NAME Clifton B Kelley LICENSE#'12087 SIGNATURE MPS MGF❑ JP JGF LPGI CORPORATION Q# 2078 PARTNERSHIP❑#0 LLC❑# COMPANY NAME:'—General Mechanical Contractors ADDRESS 129A Sword Street CITY Auburn STATE®ZIP 01501 jTEL 508-754-7366 FAX 508-756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY NORTHAMPTON MA DATE 12/03/18 PERMIT# �P—ZZ 4J JOBSITE ADDRESS,MEADOWBROOK APTS., BLDG# � d' OWNER'S NAME ABCD OWNER ADDRESS TEL IFAX! TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL❑ PRINT CLEARLY NEW. RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BOILER t BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER (— ROOM/SPACE HEATER ROOF TOP UNIT TEST ' UNIT HEATER PLUNIF INN P GA INE PEC OR UNVENTED ROOM HEATER N RT , A#3.. ti WATER HEATER / F C V .D AlED OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU 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 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. � /4-t / ,, ;,'9 A PLUMBER-GASFITTER NAME;Clifton B Kelley_ LICENSE# 12087 SIGNATURE MP( MGF JP ` JGF LPGI CORPORATION r 2078 PARTNERSHIP❑#� LLC❑# COMPANY NAME:General Mechanical Contractors ADDRESS'29A Sword Street CITY Auburn STATE MAZIP'L01501 TEL 508-754-7366 FAX 508-756-6750 CELL 508-685-8924 EMAIL jen@generalinc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES