HomeMy WebLinkAboutBLDG-16-006855 MASSACH SETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
etCITY YARMOUTHPORT MA DATE 6/6/16 PERMIT# %-,o6 V6-cvof,53---
JOBSITE ADDRESS 24 WEST WOODS WAY OWNER'S NAME GUILD
GOWNER ADDRESS 24 WEST WOODS WAY TEL 508-568-2276 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL0
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:D PLANS SUBMITTED: YES❑ NOD
APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I I II -1 I j
BOOSTERI d I i II I I
ICONVERSION BURNER • - - I I II- 'I - I
COOK STOVEd
DIRECT VENT HEATER I I„ .. I I 1 'I AI II
DRYER I II 11 1 11 'I II it ' - I 1- 11 j
FIREPLACE h 11
FRYOLATOR I I 1- 11 I I II 1
FURNACE 1 1 (— I II 'I 1 - ` 1
GENERATOR - 11 -
GRILLE I -tl I' - ,'i I
INFRARED HEATER I', r __ II IIS II I ILi I I
LABORATORY COCKS -
s _ 1 _ I iI I' 1
MAKEUP AIR UNIT ; _'I I p II I I II I'IIIIA II
OVEN I — I i I I- it I 11 I
POOL HEATER1 I 1
ROOM/SPACE HEATER 1 I l I I I'- I 1 iI
ROOF TOP UNIT �'I II 'I- t I'- 1 - 1—'I ,
TEST I' 1
UNIT HEATER I -,I II II HI_ iI II11 11 11 '1 _ 1 II (
UNVENTED ROOM HEATER I 1,1 m II II I II i „ 'I II H II- J
—
WATER HEATER ( (-
OTHER I I I 1 I tl h 1 1 I
- I I I II I —11 I I
H,r—�'— l�� II i1 II li ;1
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [Q NO D
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 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 0
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 compliance with all Perti t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE# 3880 N RE
MP❑ MGF D JP❑ JGF❑ LPGI p CORPORATION Q# 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
Lleif
ROUGII GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ T�if/T/ ,/
FEE: $ PERMIT# /L / /
PLAN REVIEW NOTES Or( 6127F