HomeMy WebLinkAboutBLDG-18-006362 Unit 605 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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4I /ITV W Yarmouth I MA DATE 10/17/2017 PERMIT# / -f)fr'l g'Wa19i6�
!!qD' JOBSITE ADDRESS 345 Camp Street Unit 605 OWNER'S NAME Charles White Management
GOWNER ADDRESS Same TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL a
PRINT
CLEARLY NEW:❑ •
RENOVATION:❑ REPLACEMENT:Er PLANS SUBMITTED: YES❑ NOD
APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 1011 12 13 m_14
BOILER l' 1, 11 11 U�Ir.-_rl (, 1111 17 li ° ,11—...1' 1
BOOSTER 11 It 11 11 11-__)I 11_J I _
11J I
CONVERSION BURNER _1 _I _I1_I1�)1_1 I�I II 1_I i _.-
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COOK STOVE _I'-_) __1,, F__i' I' I I: I_I' I� fi. _I'_I'_l
DIRECT VENT HEATER �� 1: 11_1,1JI II II I . N_r,__II
DRYER 1�1i I, )I I'iiIhI!.�iII+ I! •. H II 1i 11__1
FIREPLACE 1_11_1 _1' I'i _I_I _I I_I _) i:i!i'i _I
FRYOLATOR 1__I1_1•ilali,J'_,.-iii1 k!___ I1fI'_ ii i+iJ'il
FURNACE 1^I1 I'll' I' _J
GENERATOR I• I .il'm _.li_.l; ,..'„I'" ' I. I'_-1'_._..J'_,.--_..I�._,.....1'�.
GRILLE .
II I'_Ili-il It_II J+ - f1 I, - -11I��JL Yiri I�__-__t
INFRARED HEATER j J ! _ :
_I I I i _I i .1 _J!_J _I -11T1
LABORATORY COCKS ) _I I, l_1 I' I i' 1 - I I, - I { - I I
MAKEUP AIR UNIT I' i !.... i
�i ____J i I1 _.._f ISI� I I� . 11,_11_11_11_1
OVEN I' I' N II I' I+ 1+ 11 I; I+ DI 11 11
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POOL HEATER _I .T1 _1'_1,fI _I: I'i'�_11, 1:_ I _i it _I
ROOM/SPACE HEATER :_11_11_11 1 t_I
ROOF TOP UNIT I TI' 11_11_1'_ �
1i_JI111_-1111^JI
TEST •_.._I i _.. I U li I ..-1 1 J. _i'' _ 11 . .-11-T..._i i _ _I
UNIT HEATER - - I+.. .: : i '1 It ...�i1N ilfi .. _.11 .111_11 ..
UNVENTED ROOM HEATER Ifi-i�Ii11 ... 11_11 1 i___... _ _ + 1 -... --
WATER HEATER •ill' I `_I �i Ji 1 I - I - IF
OTHER
1 TI 1_,L1'TI'__._J 1-11_.._1111'..,,.._._1'.�1'_l1__._i'�..11
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J'.,_I �I _I1 I �_I im.J'_l l ml l_i �11. II 11
1 il'___I fI1—I'1--I'_J' l Ii.J:-_J 1_11_1 Ii L fl i
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El 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 ❑
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. /_'N/il/t /fOTU/,./C- ��
PLUMBER-GASFITTER NAME Frank Roderick LICENSE#[7794 I /' SIGNATUREf
MP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 1762-C PARTNERSHIP p# LLC❑#
COMPANY NAME: Rusty's Inc. • . I ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303
FAX 508-771-9310 CELL EMAIL ssavery@rustysinc.com
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