BLDG-18-007165 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
g.-. 'r CITY• 1 SOUTH YARMOUTH I MA DATE 6/14/18 PERMIT# b1-196'-/ '077/45
JOBSITE ADDRESS]97 S.SHORE RD f 0 c3 M a a / I OWNER'S NAME OCEAN MIST BEACH RESORT
GOWNER ADDRESS 97 S.SHORE RD (TEL!508-398-2633 (FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑+ PLANS SUBMITTED: YES NOD
APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 4 dl di I, I E 4- 0 1 II_'
BOOSTER i 7'7. !I I l I { i
CONVERSION BURNER
1Tisf -J T-T� "'L:'J' -II S-i 2�- �• - 2��•
.�I II 11 /t II II n + 11 1
COOK STOVE - y.d . _ -`
� I I
DIRECT VENT HEATER U d 1 —i
DRYER r-7r' d �J I'
FIREPLACE """rdI s Ill
_ 11 ,
FRYOLATOR ,.. ..- I d' I U P _ � I U - 1
FURNACE 1 II r: it II ti
GENERATOR �, f E s I 0 " 4 p I
GRILLE —"sr r-- — > •
tl o r. 11 Er U II 11
TWIRL,21121/122•,
INFRARED HEATER i 41 PI n1I .,._1,--„,,,, ,--_---,,,,---,,,,,..11. I I
LABORATORY COCKS �d n i1 t( N_I
MAKEUP AIR UNIT =Ii�1 ;i I I-a Ii dl-...._ I�r� _=1 _ F I
- -7— 1911222012k
OVEN ISI t, I 1111tl 11 U
2 r.- 4110.11ar 21-162,22 W2-1.12 -WNW
T 41.22121.212
POOL HEATER t! ti it ti 11 1FI ?1 I 0
ROOM/SPACE HEATER 1 t ii 1 II i 1 ti I . f 11 1
ROOF TOP UNIT
-,or art m ®. leer -•-•- nor .i`r —242." '2412- 2222.'2.- �� .•
TEST c 1 t-1 1 1 P r 1 ' I
UNIT HEATER A -h a II II n I! 1 tt 0 f1 P 1
m.o.- r-war we-a' r '--ter- -.r x r' --r:ars- -- m —`t
UNVENTED ROOM HEATER f µ1 a 11 al �'I 1 11 tl U 1
WATER HEATERe t'"wd ?, I f "_
OTHER YI ' I t —i�—; 1 I. li —11 f I
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,i 1t�tl--�1 llinS'— MI
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES El 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 ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are trueandaccurate to the be of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in rypl' nce with all P@rtin vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE#i 3880 vL SIGN U
MP 0 MGF 0 JP❑ JGF❑ LPGI❑ CORPORATION D# 173 PARTNERSHIP ID it 1 LLC❑#j
COMPANY NAME: ROBIES HEATING&COOLING ADDRESS 279 YARMOUTH RD
CITY HYANNIS STATE MA ZIP;02601 (TEL 508-775-3083
FAX 508-534-1272 CELL'508-775-3083 EMAIL MARY@ROBIES.COM
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: S PERMIT# /✓ l/ 1‘% /---
PLAN
% /PLAN REVIEW NOTES
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