HomeMy WebLinkAboutBLDG-19-001262 Unit 504 ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
49 go CITY Yarmouth I MA DATE 8/29/18 PERMIT# "9/-92b-M-6,9/2 ,
JOBSITE ADDRESS 345 Camp St,Unit#504 I OWNER'S NAME Ravenswood -Charles White Management
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' OWNER ADDRESS 330 Commonwealth Ave,Boston,02115 TEL 508.889.1445 IFAX
TYPE OR' OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES NO EI
APPLIANCES 1 FLOORS' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER _I _ I ___I _ Ila_,I _- I'_--_I _ I I —I -_—I I I I
BOOSTER I
, I_ ' 1,—.11 _II I' I' 1, -li II I''_I i.__ I I I
CONVERSION BURNER 1172-11___11_,„11...1_723'__1' Il__,_ I1____ll... ,_T I!., ...11-771 _ II___. I177.1
COOK STOVE w,_,I —I' u-li.—!' I'_ 1' 1 _I'_____1'_1 ._li.._ 1_. I' I ____I
DIRECT VENT HEATER I'_I'__11 1'1_J'__1 L__.I1.____)' I_11,___1' 1' I _J'--I
DRYER (' 1' I,�1 I' lI '.11'�_1i -Ii 1i�i Ii�1" 1
FIREPLACE I—I _., 1 II-„ _¢' _.l'_ AI' 1'__1 1 -.I _ 1_ _I_f',_ 1
FRYOLATOR I I' I' 1i _I! I'i I'. II 11-1I -11--1,--_I -. -1 _III
FURNACE I I, 1 ___1,�1;_ I' I, 1' 1, IF I, 1'— I, I I I
GENERATOR i_I ._I ..—.1' _1` I 1.—I _ _I 11 1,_ I -.--111-...1 --J
GRILLE. I I'_ I;_ ,.N IIS 11_._._11 I! 11_._.1,_ _____-11______I 11__.f1�I
INFRARED HEATER I_ llI,—_11-) II^l —II_I!,. I n_1{—li_ _ -I1�I'__I __ _1
LABORATORY COCKS �I'vI_I I` I' 1 I' I' 1 I' I ' I __I
MAKEUP AIR UNIT .� I II._, I '_f .—
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OVEN —I'`l, : 1 ' III_ r"— I1_—P I'_ ' fi_,.._rI ., I
POOL HEATER I ) ..___.I _YI I _ I =_I 1 _I I
ROOM/SPACE HEATER I 1' I'',1'—II'^I'_II I'—,_ I'___II''_ I
ROOF TOP UNIT I I —I I! I i' _ I __I'_ I _ _.I — I I'__—I
TEST 1 I .. I — I'____ -I _.... .I , ....11' _ I' , _ . _1 I -�.I
UNIT HEATER _I'_11; _f _f— _
UNVENTED ROOM HEATER 1 1' I'—I' I II =R= rt--1 -�_' _E_ - I.-1
WATER HEATER _ _ _
'; OTHER Gas Test I— I1 1 II I _ II _. J i 1g Q_2I la_I .._ I
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INSURANCE COVERAGE ' ' /0 %e
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LI NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q 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. 72014 JRodeitie4
PLUMBER-GASFITTER NAME Frank Roderick (LICENSE# 7794 I SIGNATURE
MP 0 MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 1762-C PARTNERSHIP❑# LLC❑# J
COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303 J
FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com
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