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