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HomeMy WebLinkAboutG-13-821 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK C ';Wstfi'I=, F ki CITY alt- ovW.Zinn ______I MA DATELa 41 ---]PERMIT# /775- gc2/ ,.,ThSit j JOBSITE ADDRESS `-'.L�xa� Y��b OWNERS NAME GOWNER ADDRESS [. _ .•W JTEnC6 FAX TYPE OR OCCUPANCY TYPE COMMERCIALE] EDUCATIONAL 0 RESIDENTIAL EP PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES© NOD APPLIANCES 1 FLOORS-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - -1`11- _ilW ' -, I-1-1-1----_. ..; ' ''mo i_ _II_ BOOSTER I—_.i I 1 I—I I_ 11___11 _._ 11_ 'i-..___IL . 1- (_..___I ilI CONVERSION BURNER I C Cl I_...__`!__.'I _..-..il__.__4 `L !1 'II I "1 COOK STOVE DIRECT VENT HEATER II ...I! . . .J1—Ii Il ' ._.__..1 .-11 )i. .!L . ..,r-`I DRYER it — II .. 11- i1 I _.._II-__'1 II iI �'I31 - FIREPLACE ;111 - -i 1 FRYOLATOR 1 iI_ I1. t(—II_ ._ '; I--I--i— �1 FURNACE IF _._11_ _11 II__..II i1 II I- L '1- GENERATOR _.. fl f JI ..-- . - -I lI . 1 GRILLE l _ II II II— .'L II 'I,._ .. ' 'I I 'I I I I _"_ INFRARED HEATER 't . III 'I 1I—I, 1 I IL 1 ._...'I. "I1 _.._.,'�i ' ,_ LABORATORY COCKS I I Ir '' I I MAKEUP AIR UNIT - I ill 1�.1I2 I _SI_._._ I__=.11—_ I i I __ 1_ 1_' 1 1' OVEN i I. 11 I ! III I— 1 POOL HEATER I 1 'I �_ I ROOM/SPACE HEATER _ '1--- _.I ._._II-_ _ I ----II- ---I ._... �I , _ij'-- -1--- 1i1----1 ._'I __It_ ROOES •• :I '1 I UNIT HEATER - I .... UNVENTED ROOM HEATER WATER HEPTER r OTHER __ ' '-'1_. . '�1—'.. ._ 'M'._ '.. _.MI.__._'ill 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 Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY Q BOND Q 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 Q AGENT Q 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 ccurate to best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliant With 'orlof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME[Joseph Ventresca !LICENSE# 15742 SIGNATURE MP ID MGF Q JP Q JGF Q LPG!Q CORPORATION Q#rialill PA RSHIP Q#1. - I LLC Q#' J COMPANY NAMEI South Shore Heating and Cooling ii ADDRESS 157 Whites Path CITY South Yarmouth ' STATE MA ZIP 02664 1TEL LE z88$901 -, I FAX 508-760-2681 .1 CELL[508360-5277 JEMAILC1oe@southshoreheatingcooling.com - _ � ...�.. . 1 MAR11 013 j /fed CK#,pliyo ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 El FEE: $ PERMIT# PLAN REVIEW NOTES A. •