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ZJ. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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n— 1 _11 ( MA DATE J011'7.UIe) (PERMIT#8' 6-�a2o207
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ti JOBSITE ADDRESS6 S1 S 2-8 I OWNER'S NAME M I-10 <0 St14 S gales, <&7(
G OWNER ADDRESS SrN Rtyt(. .aJ3tX Z60, c-i1 A/vtnd\ -L I TEL 508-3i 7 ti 3 SR I FAX
TYPE OR OCCUPANCY TYPE COMMERCIALZ EDUCATIONAL ❑ RESIDENTIAL Di
PRINT
CLEARLY NEW:Er RENOVATION:DI REPLACEMENT: PLANS SUBMITTED: YES El NOE(
APPLIANCES 1 FLOORS-, BSM 1 2 3 0 . 5 6 7 8 9 10 11 ® 13 14
BOILER .1 _,._ 17.-Mnilikal ill111. MOW imp imais_jammorAm
BOOSTER IMI,�I �'1M'W,: i ,= 1s'
CONVERSION BURNER ' flI[fli ,11.I J1111111 ;111111all
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COOK STOVEimiiii• _IS mi, 'SirilaiSitilla—_
DIRECT VENT HEATER a,illiall(aimilW; , Sunil—I�.�i—a
DRYER Mlilla.17 IntiMli iMILIMIti='ce? 1
FIREPLACE Nig Mi , a11111 I�MOI lam. ice, ,
FRYOLATOR S]sitsti --i_a_jafw_l riptimio aminarim.
FURNACE 111110iW! IIID WIrllllllll�,1 lime,*NM M11I S::[ MP'
GENERATOR M �'WI�IM=IW �I1MW�J..-
GRILLE ,11• f��S_ ,— iii�!b�,owllijali ,
INFRARED HEATER j�.� ;'5 fl��i l 'il J 1___
LABORATORY COCKS I�:I� ISI ,� I ■I>•j1�
MAKEUP AIR UNIT Mili.11J i=' 1.111'L 0110.411._NM Jai '
OVEN d�,l�u i� I SINN IS OM ll=1,007
POOL HEATER ;�. �j M='.—M M'—. �I 'a M.
ROOM I SPACE HEATER 1111.1111111111111.1nlia III.ai � 'd m: '
ROOF TOP UNIT 111Mallialli 1111.1111111111.1.111111MI ililliall1.111jaM
TEST NMSiMiir01111IMIJes111• b :
UNIT HEATER r1 ralIMII 1 N Ia as issI_lJ 'i:
UNVENTED ROOM HEATER ��i iIlt=,t', 111=j1'itil____ I
WATER H 'T R 55 WI I 1'1_1 I ii -illi. __
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INSURANCE COVERAGE
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES []NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTYINSURANCE POLICY O' OTHER TYPE INDEMNITY 0 BOND 0
OWNERS 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 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT
1 hereby certify that all of the details and information I have submitted or entered regarding this application are two and accur • of my knowledge
and that all plumbing work and installations performed under the permit Issued for this application will be In compile •= with all •- ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME R.PETER CHECKOWAY LICENSE# 13417 der NATURE
MP MGF❑ JP❑ JGF❑ LPGI 0 CORPORATION Q# 4008 PARTNERSHIP❑#— LLC❑#
COMPANY NAME: BOURQUE HEATING&COOLING CO ADDRESS 1199 PITCHERS WAY
CITY HYANNIS STATE MA ZIP 02601 TEL 508-790-2887
FAX 508-771-9696 . CELLI 508-735-9993 IEMAIL info@bourqueheatingandcooling.com
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 S ) V,y� 6/B
PLAN REVIEW NOTES
ply C/2 //