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HomeMy WebLinkAboutBLDG-18-002953MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GOWNER TYPE OR PRINT CLEARLY CITY I WEST YARMOUTH MA DATE 11116117 PERMIT # 5496 /8' wo2�f 5� JOBSITE ADDRESS 361 GREAT ISLAND RD OWNER'S NAME I SWEAT ADDRESS 1361 GREAT ISLAND RD TEO 978-502-8605 � OCCUPANCYTYPE COMMERCIAL❑ EDUCATIONAL[] RESIDENTIAL Q+ NEW-.[] RENOVATION:, REPLACEMENT:O PLANS SUBMITTED: YES❑ NOQ APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 1 6 7 6 1 9 1 10 11 12 13 14 BOILER q 1 1 1 I 1 1 BOOSTER I - I 1 ; - 1 CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I l ! I DRYER l _ ! 1 1. FIREPLACE A 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS —1 MAKEUP AIR UNIT OVEN POOL HEATER k ROOM /SPACE HEATER I --I I1 I 1 _ t_ 1_ 1 1 ! 1 _t ROOF TOP UNIT _ 1 TEST L UNIT HEATER UNVENTED ROOM HEATER WATER HEATER — __. 1 . 1 _ _ _ 1 . GAS PIPING ((REPAIR -_l INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES ONO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C] 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 Wst of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cergpliance with all e ' provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE #13880 SIKINArTURE MP ❑ MGF 0 JP ❑ JGF ❑ LPGI ❑ CORPORATION Q+ # 173 PARTNERSHIP ❑# LLC E]#� COMPANY NAME: ROBIES HEATING & COOLING ADDRESS 1279 YARMOUTH RD CITY I HYANNIS STATE MA ZIP 02601 FAX 508-534-1272 CELL 774-836-5659 IEMAILIMARYRROBIES.COM ivy Lull I RTMEN @DMJ ROUGH GAS INSPECTION NOTES THIS PACE FOR INSPECTOR USE ONLY Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ _ PERMIT # PLAN REVIEW NOTES FINAL INSPECTION NOTES Ll