HomeMy WebLinkAboutG-19-3273 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
®c 1= CITY Yarmouthport 1 MA DATE 11/27/18 PERMIT#/f- ere//"�3c27,
$60 JOBSITE ADDRESS 714A Route 6A-2nd floor OWNERS NAME OLouglin,Inc
GOWNER ADDRESS 2 Harold Street,Harwichport TEL 508-362-4942 f FAX
TYPE OR OCCUPANCY TYPE COMMERCIALE] EDUCATIONAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOD
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 _ 7 8 9 10 11 12 13 14
BOILER t. i f m f J e 1 f ._. .." l' '
BOOSTER I 1t _f r 1 .__ t r __ 1 1 1 f t i
CONVERSION BURNER I f I I f` f' I ..�_1 1, t'r11 f Ii_.._ II
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COOK STOVE — _R; ' . . R' I . :, I, E' F I
DIRECT VENT HEATER I f 1 I_ I I' , 1' t fi ti ,. f R a
DRYER / t�,�1`— J' " '. _ F ll t PI
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FURNACEO __ r _,.... fl _�I, l f 4 .e� E t� f ! 1
GENERATOR 1 t ._ I 1 t t 1 r r t Q f
GRILLE I I i I, _tII'' II I —R !I t I f R f
INFRARED HEATER 1 ii- f k -t
LABORATORY COCKS 1 I F ih r ~- - " t
MAKEUP AIR UNIT _ J _1 _ °�-f, 1° fi�_ tr { G � I . t p: "ft.
OVEN , f _ , fl 1 __I -r ' �r f f
POOL HEATER R t _ t �/ 1 f� f t
ROOM/SPACE HEATER
ROOF TOP UNIT I ki ti 1: ` 3 t'- I ti
II B--1-L f-C p &j f 1
TEST .v I'. 1 __. .. —'
UNIT HEATER I 41 f1
UNVENTED ROOM HEATER I SII I Ii I 11 II RI I I I R t I o
WATER HEATER 1 . - I .. t... a f =. R t.:.._ . t K. . ._- ! .t ' w, - Cl
OTHER �� R —I li f I I 11 1 1 r R
l' f' 1 ._ f Ir._ I t' l 1 11 R
1. Mill 1 7 6 f 1 1 ....._.f'._. I 1
1 ( —t;,. l i- _. 1 ..:_ i --11. ..:.— .l .�.l _.RI 11 11—_-I. ._ ; 1 .._. I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 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 0
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. 72444 R j
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PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE
MP a MGF DI JP❑ JGF El LPG' CORPORATION D#11762-C PARTNERSHIP®#` I LLCD#1-----1
COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth 1 STATE MA ZIP 02673 TEL 508-775-1303
FAX I 508-771-9310 (CELL EMAIL mburke@rustysinc.com 1
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