HomeMy WebLinkAboutBLDG-19-001615 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY WEST YARMOUTH I MA DATE!9/13/18 I PERMIT# /fr—Ob—/7p'00/6/'
JOBSITE ADDRESS 177 WEBBERS PATH I OWNER'S NAME 1 BAUDO
GOWNER ADDRESS 177 WEBBERS PATH I TEL 508-394-3377 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL`] EDUCATIONAL❑ RESIDENTIAL'a
PRLNT
CLEARLY NEW:',] RENOVATION:] REPLACEMENT: PLANS SUBMITTED: YES j NOD
APPLIANCES 1 FLOORS-. 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER {
CONVERSION BURNER
COOK STOVE
—
DIRECT VENT HEATER _ _
DRYER
FIREPLACE • 9_ T._.n: _' _
FRYOLATOR T
FURNACE t �'
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER ,
ROOM/SPACE HEATER ' i
ROOF TOP UNIT
t , ,
TEST UNIT HEATER
_.r
UNVENTED
WATER HEATER
OTHER I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ]
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY r' 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 wilt be i pliance with all Pert' ennt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (Llitinv
PLUMBER-GASFITTER NAME I ADAM TRAYNER I LICENSE# 3880 GNATURE
MP El MGF'a JP;] JGF i] LPG'] CORPORATION.#1173 PARTNERSHIP]# I LLC]#'
COMPANY NAME:!ROBIES HEATING&COOLING I ADDRESS 279 YARMOUTH RD
CITY I HYANNIS STATE I MA I ZIP'02601 TEL j 508-775-3083
FAX;508-534-1272 I CELL 508-775-3083 EMAIL!MARY@ROBIES.COM
ROUGH GAS INSPECTION NOTES TIIIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
awe d .•
•� to-,
PERM
FEE: $ VIE # e� L_
PLAN REVIEW NOTES 2