HomeMy WebLinkAboutBLDG-19-003001 •
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
,vkl-s' CITY i14/Y110/1 Ii1I MA DATE Ili/b/ifl (PERMIT# *1)6-19_ 5"(
JOBSITE ADDRESS 74 A4,00n l'Le�LOVA-C. I OWNER'S NAME cUva�d gf I
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OWNERADDRESS I 341.44 C J1 TEL) Sun -() II -c-/YrCIFAX
TYPPE OR
OCCUPANCY TYPE COMMERCIAL❑ ✓LJ
EDUCATIONAL 0 RESIDENTIAL
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES NOE(
APPLIANCES 7 FLOORS-' BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14
BOILER 0301 I I m',mi ` :Sljmorin
BOOSTER -11af , Iii I! W�] IL
CONVERSION BURNER 'Mt
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COOK STOVE SSill� SSS SS]al
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DIRECT VENT HEATER Sfi,NINNINIONIIJ_ J=1� , Ii isms,pm um:sans,
DRYERh'If■�f Sita_=I��iJ tio•= i` i
FIREPLACE ____I___________;
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FURNACE SI 1s!I.is INNIMP141111111
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INFRARED
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ROOF TOP UNIT 0111110071SalMlintallfflilltitimilimilaim
TEST NM MIME IaM•IMll• 5MITIMINIJ__a
UNIT HEATER 11111101.01.1111011111•1111111.11111111 IMI.illISIMINS
UNVENTED ROOM HEATER S<ISlljIIMiiNRi IaMMI,, . ... i,a. :IIWINI M]S jam_
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INSURANCE COVERAGE
I have a current Jiabilily insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES [I NO 0 lit
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTY INSURANCE POLICY '❑ 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 0 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 accui/ •:- of my knowledge
and that all plumbing work and installations performed under the permit Issued for tis 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 ir NATURE
MP❑+ MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION 0# 4008 PARTNERSHIP❑#— LLC D#
COMPANY NAME BOUROUE HEATING 8 COOLING CO ADDRESS 1199 PITCHERS WAY
CITY HYANNIS STATE MA ZIP 02601 TEL 508-790.2887
FAX 508-771-9696 . CELL 508-735-9993 (EMAIL info@bourqueheatirgandcooling.com
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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
FEE: $ PERMIT tl / Ca/1r
PLAN REVIEW NOTES (/
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