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HomeMy WebLinkAboutBLDG-19-001734 • CA., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ‘-::151;;-1 ' CITY cS• ti Clod Oti`FI'1 I MA DATE' C7 /g{ ZPl i g I PERMIT#1))/426-17-00/Z 7 JOBSITEADDRESS •Gb Net: REA IOWNER'S NAME-Kw alC1 vet/enD 1 G OWNER ADDRESS I S (4 it Ufrkttll J.gvhvrti ,Mgt ITEL 5UQ -612- Oaau(FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL{ PRINT CLEARLY NEW:DI RENOVATION:El REPLACEMENT:O "--- PLANS SUBMITTED: YES NDE( APPLIANCES 7 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER a_MIMAIMMAILMEimam.MIma amosa BOOSTER _''i��1.11 1[�1r_n:t__,i;�l_ I�_, CONVERSION BURNER ' INMI1I S•falllin gt llS=SSI COOK STOVE VIM MiIfl= ;LIMiJl�: , ISSSiS DIRECT VENT HEATER .1111.1.1l l5_ ,—, a i l .I,=s DRYER _I_1Il>�1[il>•I fllllll�i �ilaM,1NNI FIREPLACE SOS.�S IMAMS, FRYOLATOR �I I�iS____ tiara ma�lll S FURNACE ■III„5'[ [fflllll•7 , l llit,1 ;ImiiWallis"PMSI GENERATOR __-- .11 _ ___J_�I1___Lrl - GRILLE JPWIM 71.1111 ; !l11.111ainiliialila. I>•11111; INFRARED HEATER Am]a[ lift{II SWicfaaanak jt 1fr LABORATORY COCKS nil_'fl ice;[ PMi 'WilammilaislialatmI MAKEUP AIR UNIT Imill.1111.011.11.10INILIMIlaaijim,Nola'aina( OVEN I lfll CIMMIi S a...IMF F l l ;at,IIIi; .j POOL HEATER moia.S S a as 5 OsSal Mill soma ROOM/SPACE HEATERS1,S6111110011,� a,W,��ISls', ROOF TOP UNIT u iMMI[aI _ lIIIM.SiI [I•' L_+ISaiir✓0low TEST NM_[ rlimi_IM:Wi___ _MAIM lWAWA UNIT HEATER __JI_i__I__I _; Ill Ln., UNVENTED ROOM HEATER IMIlEIMESIEW.TIMINSMIllMR[ I_11111,101•111111111111111a WATER H •TER ,1111111,011111011111111111t ill.LW PM.WSaUll g.Pl 55 [isItii Jllll lalGollaJt'_, 'a ';o'Sifflf ! ;ice I—IataI Jlflllltil jIW.M��-MIs: _____I_aaiMIC asi—ftiti INSURANCE COVERAGE I have a current Jiability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES a NO ❑ I IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY I] OTHER TYPE INDEMNITY ❑ BOND 0 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 t. i ,..t of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In complian•: 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 dir NATURE MP I❑ MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 4008 PARTNERSHIP❑#— LLC❑# COMPANY NAME: BOURQUE HEATING 8 COOLING CO ADDRESS 1199 PITCHERS WAY I CITY HYANNIS ( STATE MA ZIP 02601 TEL 508-790-2887 FAX 508-771-9696 - I CELL 508-735-9993 EMAIL 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$ P'1 , 11 PLAN REVIEW NOTES f ofc jjarb