GP-85311 ' TOWN OF DARTMOUTH -IIUILDING DEPA TMENT RECEIPT '11
PHONE: 508-910-1820 FAX: 50,8-910.1 8
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Name: ,'--C% -, Pro e wn / 4-/ z-' r" : '
Job Location: //5 `2j� . L/iit'A ,7 i Map: `- t ".Lot: '-''° (.77
Description General Ledger#'s Ref. # Amount
Building & Building Misc. 01000-44105 71-.DARTNj��
Electrical -- 01000-44106 :,, Ms >,
Plumbing ' as 01000-44107
: itiop_1". ,,,, 7 2 ,r--2,- )
Trench Safety 01000-44129 6 oQ;.
Other Department Revenue 01000-42420
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS
p'„ MASSACHUSETTS UNIF•'RIM APPL9CAeNON FOR A PERMIT TO PE*FORM GAS FITTING WORK
tell
�°'•f=. 'CITY I_ �t 1 MA DATE -/, ; PERMIT#
JOBSITE ADDRESS �r� ..A_J —_I1 OWNER'S NAME /J _- � �'_.____
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OWNER ADDRESS _..._,... _ . .. _..... ]TEL.. Y, 7/'/'`/`�_I FAX �—�
TYPE
OR OCCUPANCY TYPE COMMERCIALD. EDUCATIONAL 0 RESIDENTIAL]
PRINCLEARLY NEW:1 RENOVATION: REPLACEMENT: . PLANS SUBMITTED: YES,_; NOO
APPLIANCES 7. FLOORS-b BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I-__<_i I.. . I 3I�,�._._,!I� _I:_ I-_._ [ 'I _ I=i. 'I- .,_�! 11— _-j
BOOSTER TD -_ C m.'I. 1._ i h__r I I. . .._�I___ _J __ I I I. .- 1- r__ 1: _(.. �,
CONVERSION BURNER I�_ _I ,_-,_ . __ = 11_1I, - I I_ .. I__ 11. _II _ i'I 1_-. 1 _ =
COOK STOVE _II :1 lI II . T __ ! 1 _ l iii _ j _ __ --
1— n T t __
DIRECT VENT HEATER [ I [r,_!I. _ t I L- -T l I .,I. ._.I 1. L _:1 I 1- --.-.[ [__�_,_:
DRYER f___I I .., [ I1 ,_.-EL_ __IL_ _ 1 I ._ ._ I i 1 _11 : _I .___,. 1._ . _.1< �I 1-_,;,...,c,.T_.
FIREPLACE I I I I_r 1!__, , I,______SAL_______ i_ I. I__ I---- lI.___ II.____I L zl 1 --_
FRYOLATOR I_... ,I . „.1 I r .J[.. L.,__ ;[ _ _'l ,___,.11_...'._ ,I I I__ra It-__. [.____ ., , -- I._ . L
FURNACE Lt=-1 I __:[ . , _,I I . I„_ _I I_ i I. I !1 . _,,.:'I I I I I_ 1 -i -
GENERATOR I_ i 1_.n`I [III I ._ 1.,.,...„:i .,._. 1.._____[,.. I ! 1 1{ 11
GRILLE I-.._I1 I_�_1 I J[._ il.. I 1 _. __ _ 1 l -
INFRARED HEATER I _f I f 1 I I 1 1 J I l ;L, --- 1_ .:1--_,)
I ___:1-----_ l
LABORATORY COCKS 1 _1 I I.,., l L_. _'I_,_ i 11_,:,I :1 _ I L I I 1 __I I _I i___--I i--
MAKEUP AIR UNIT I_,=11 !I - [ I _ 11Jr_ _i I I I I l ! I [ it c-'
OVEN _
( m�a I - I [ 1[ I I I �. 1., i I I f i
POOL HEATER I 1 I it IL I I . 1 L. I LilI ,i !! {
ROOM/SPACE HEATER 1 I I I[ 1 i 1 . I 11 1.117 CD 1 - [I Er.:1 r._, I L
ROOF TOP UNIT - - I —
_J L ..,��L _�,, % !1.__r1�_-�1. �- I _�. 1_ __ f _ i_� { __-;I _ L T L
TEST I�,.__��L .JI L , L_..I.i I..� ,,„ I� _m :I ...�_1 I____ 1,„.,____:I._n_ 11____,1 I I --.i 1__T-._zi
UNIT HEATER 1.-..I_i ..,..._°[...:.-�:_,�'l _ 1= ,.;L I______!I .-___i I, _-�(I.__. 'L... ;L _-_.._.,_'=.__ L,I_ [ ,
UNVENTED ROOM HEATER JI — ' 7 i EL-) _
WATER HEATER L- 'I - lI - I li I 1 '1 1 r I 'I _{ __I{ !1- -J
€ud'pe _ I ..---'1_...J-`C.._,�_. I -- I I -'[._ _ L. L,.. �!1,� n l _-_I._: L _=1 _:I-- `1--_
OTHER
.- .M . ...-...: u__ I I 1 I I[ 1 I [ 1 1 I I [ 1 I 1
i L I :I I I, I ; �[ f I I I i t = I I 1 -1 -i l _H__
1 L .__..� L_.... [ c i[ ..�_--,;1_..__ ,1�n_.,�.,.1 1. -.i I�_��. . 1« �_. I_ . 1 ____ 1 L.,
INSURANCE COVERAGE --.,
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES -'J- NO Di
I IF YOU CHECKED YES,PLEASE INDICATE-THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1__ ,I • OTHER TYPE INDEMNITY f_ BOND ID
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: 71 AGENT I..__1
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 accur e the best o knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in c i ce with a ertinent provisio the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAM s Y . LICENSE#,_9:,;/ :I
MP D MGF L_I JP[_II JGF1 LPGX CORPORATION L.J# ____ ___ _I�PARTNERSHIP 1._-1# ,__,,,,, I LLC Irv•r•#JT 1
COMPANY NAME: OSTERMAN GAS ADDRESS 42 FIRST ST ^ _-
CITY BRIDGEWATER `j STATE MA '1ZIP102324 TEL 5086973131
FAX 508 697 3175 CELL Q �.-.. IL-•— --
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