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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
ItgCITY SOUTH YARMOUTH I MA DATE!7/10/18 I PERMIT#/ /96-%CT`QOQa7
G JOBSITE ADDRESS!97 S SHORE DRIVE UNIT 207 I OWNER'S NAME OCEAN MIST BEACH RESORT
OWNER ADDRESS 97 S SHORE DRIVE UNIT 207 TEL 508-398-2633 'FAX;
TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONAL [] RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:D REPLACEMENT: PLANS SUBMITTED: YES❑ NO=
APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNERS5
COOK STOVE � 111101111111111 S—
DIRECT VENT HEATER
DRYER -- S
FIREPLACE
MII1101110111110.111/01411.1111111111aSIMMIIIIMEMIESIIII
FRYOLATOR ...: 111111 IPME �j J
GENERATOR alltallilialla.1110111111111011111111SIMPIIIIMINUNIN
GRILLE
INFRARED HEATER
LABORATORY COCKS 1101111011M11111011SSIIIIMMINMENIIIIIIIIMIlalla
MAKEUP AIR UNIT 1111111011111aMISPOISMAINIMPOIMEIRMINIMial
OVEN
POOL HEATER
ROOM/SPACE HEATER 1111111j 11.1111
ROOF TOP UNIT 31111111111101110111101111111SPIONIMPIIMISISIIIMIMPINIIIII
TEST
UNIT 11.1111.110.0111111101111111100111101111111.0111.100011111.0.111.1111111
UNVENTED ROOM HEATER501. S
WATER HEATER
OTHER I i S j 1.0
1.11111allaniklaillialliallW101101111111131111.
1 IMMIUSIMPOSIllaMMISIMISSIONIENSIIMINUIS
INSURANCE COVERAGE
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO Q
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY Q 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: OWNER0„ 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 to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be i cwn Hance with II P ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER I LICENSE#;3880 GNAT RE
MP❑ MGF Q JP❑ JGF❑ LPG!❑ CORPORATION a#1173 I PARTNERSHIP D#- + LLC Q#
COMPANY NAME: ROBIES HEATING&COOLING ADDRESS•279 YARMOUTH RD
CITY jHYANNIS I STATE MA ZIP I02601 ITEL I 508-775-3083
FAX i 508-534-1272 I CELLI 508-775-3083 IEMAILI MARY@ROBIES.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 9 9 11
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FEE: $ PERMIT# 1 -1t/A-
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PLAN REVIEW NOTES