HomeMy WebLinkAboutBLDG-17-003231 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
iTIP LE" CITY YARMOUTHPORT MA DATE 12/8/16 PERMIT#0-017-17-06123
JOBSITE ADDRESS 34 WEST WOODS VILLAGE OWNERS NAME DUNN
GOWNER ADDRESS 34 WEST WOODS VILLAGE TEL 401-524-7030 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:a PLANS SUBMITTED: YES❑ NO0
APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I tl A 1I I� I
BOOSTER - s41--- i1 1I I II I( II I
CONVERSION BURNER L. ti 11 , II' ' 't1 'I ' I II - it -U I f
COOK STOVE I I I I #" I
DIRECT VENT HEATER 1 q 91 SII- II I SII ll --'1 I
DRYER r II 1 'll ( ii " I
FIREPLACE 1 I s
FRYOLATOR I 11 Ih 11 d
FURNACE i t 1 • II II I II -1 tl - -'I— '.f
GENERATOR .I � — �
I • 1 1 _.-.- : _
GRILLE 1 IF II n J liI I 1—
INFRARED HEATER N 11 f 1 f l I I
LABORATORY COCKS ' I T r,
MAKEUP AIR UNIT -A I 91 d 'i 11
OVEN 11 11 1 Ii - 1 _II_ -..I..- 'I- -11 I
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POOL HEATER k_, tl I I8 I
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ROOM I SPACE HEATER t I 1 i 0 I .I
ROOF TOP UNIT Q. I 1 II } I
TEST I 4 1
UNITHEATER Ij i 1 9 _ II
UNVENTED ROOM HEATER _ n _ I I ( - tl
WATER HEATER I .
OTHER I I II _ :I I. 1
I I 1 I II 11 II
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it ,i1 I II i , 11d1I II I f
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 0 OTHER TYPE INDEMNITY ❑ BOND 0
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 i mpliance with all Pectin t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE# 3880 SI N RE
MP❑ MGF 0 JP❑ JGF❑ LPGI❑ CORPORATION 0# 173 PARTNERSHIP❑# LLC❑#
COMPANY NAME: ROBIES HEATING&COOLING ADDRESS 279 YARMOUTH RD
CITY HYANNIS STATE MA ZIP 02601 TEL 508-775-3083
FAX 508-534-1272 CELL 774-836-5659 EMAIL MARY@ROBIES.COM
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 9 9
FEE: $ PERMIT# fer, // `� 6
PLAN REVIEW NOTES 11