HomeMy WebLinkAboutBLDG-19-002383 , I---. I ,
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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i Ji CITY I SOUTH YARMOUTH ( MA DATEI10/17/18 IPERMIT# 246 Qft5�V
JOBSITE ADDRESS': 138 CAPT NOYES RD I OWNER'S NAME 1 ROBICHAUD .
GOWNER ADDRESS I 138 CAPT NOYES RD +TEL 508-775-3083 ]FAXI 1
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL',
PRINT
CLEARLY NEW:) RENOVATION:') REPLACEMENT:El PLANS SUBMITTED: YES) NOa+
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
—_ —
BOOSTER I 1 ,
CONVERSION BURNERt'
COOK STOVE _____ _? _____ . : __ _ ____ — ___.. -__- _— ___ _ _.-
DIRECT VENT HEATER
DRYER .
FIREPLACE ;_ — - - —
FRYOLATOR
FURNACE r.. � - I
GENERATOR - - -_
GRILLE i,- - -
INFRARED HEATER1
LABORATORY COCKS
MAKEUP AIR UNIT [ I - ' l I
i �" p 4 —
OVEN
POOL HEATER r - -* i" , —
ROOM/SPACE HEATER i T' —1
ROOF TOP UNIT I 1 _— _ _ _ _- _ _
TEST - t • —
UNITI-EAT - ��.c� a I_ 11 �f '� _ '
UNVE I74 i� inial _ — --
WATE' H, _ , ' ��� , ,
OTHEF I �i — �:
_ L. cia i_9_201 - _— - _
DIM c;JE.PAFtTuEL�II_ -- — F -- - --
warn=---- INSURANCE._. .
COVERAGE
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 IIA OTHER TYPE INDEMNITY ❑ BOND LI
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 iEl AGENT E
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 bes f my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in�pr/90-41V
pliance with all Per inen vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /�1 Dam
PLUMBER-GASFITTER NAME i ADAM TRAYNER 1 LICENSE#,3880 11( ••�SIIGGNNNN URE
MP E MGF JP J JGF❑ LPG!Ij CORPORATION EJ# 173 I PARTNERSHIP',..J# 1 LLC Di I
COMPANY NAME:',ROBIES HEATING&COOLING I ADDRESS 279 YARMOUTH RD --
CITY !HYANNIS— -- --- .-1 STATE MA I ZIP 02601 ITEL+508-775-30834—
FAX 508-534.1272 I CELL'508-775-3083 (EMAIL'MARY@ROBIES.COM -- -__� i
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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 0 0
FEE: $ PERMIT# I CY//6
PLAN REVIEW NOTES 099: ida 6/7