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HomeMy WebLinkAboutBLDG-19-003458 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ':'=_I_i- CIT$Apt i 1A,(cvl v1 I MA DATE 1(113 O/e 8 (PERMIT#SP679-0V l .. JOBSITEADDRESS S7 Cikia (MAK frt.Ravi !OWNER'SNAME Ridlitt4 pansI GOWNER ADDRESS 141 Or het4 t-, utdia,..),Av'I/� (TE gatyrr wnFAX TYPE OPRINT OCCUPANCY TYPE COMMERCIAL EDUC TIONAL D RESIDENTIAL I Ts CLEARLY NEW:❑ RENOVATION:CI REPLACEMENT: PLANS SUBMITTED: YES NOZ APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 8 7 8 9 10 11 12 13 14 BOILER aMIIi_II SWIM M' mliampima BOOSTER CONVERSION BURNER MOMI�� I��ryli �J _] COOK STOVE �.�� i_] �_il�_iaimiltalla '' DIRECT VENT HEATER _;f__l001j_]_,_,fi.1;,1M1111. IIIM]NIIIIi[ DRYER ar______�rll MIa ,�.�! � I �i�111=f:1. FIREPLACE _S ti_.- 11.S.101.101111.111.1.111.11...0.1 FRYOLATOR Minna 1.111i3 M. FURNACE SI*fc4'llfll11110,1101S ] 'Il1 I ra 1` ' GENERATOR .aana amit. '� �jsim GRILLE 111111111111 .7.1.14-110- ;i�'_'i_'_ M'_ ,_' INFRARED HEATER LABORATORY COCKS NM._'I 1.0111.1 I_.'I .JIMill..(11.1,11110.1.11111111101.11. MAKEUP AIR UNIT �;i�li��i��' � '��tM111.1 )11111, J♦! OVEN _;_I_i :ala( i;t_aaaa . POOL HEATER ,11111,I. _ S O.at tI_]ism , ROOM/SPACE HEATER _]�] ��_� �'il�'1;�, SIM I( ; ROOF TOP UNIT .[rneila lis1 JS 'rna' TEST S .aa almaaaaianiska' _ UNIT HEATER 11111011.1111.110111111MONLINDMININE IMallia UN VENTED ROOM HEATERl�MINT11_I_'_;ai ilinf ll_ ainim WATER HEATE' tl_I0 _—'—se's__'Ss SISMINPlimiWaml'MUM MIMS a Iaraa ala aai_a __Ia a., . INSURANCE COVERAGE I have a current Jiabilitv Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY 9 OTHER TYPE INDEMNITY 9 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 true and accurate t•�,:�' =- of my knowledge and that all plumbing work and Installations performed under the permit Issued for Ws application will be In complia • with al L37'i ent provision of the Massachusetts State Plumbing Coda and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R.PETER CHECKOWAY LICENSE# 13417 NATURE MP 9 MGF 9 JP 9 JGF❑ LPGI CORPORATION Q# 4008 PARTNERSHIP[Pt— LLC 9# COMPANY NAME BOURQUE HEATING&COOLING CO ADDRESS 1199 PITCHERS WAY CITY HYANNIS STATE MA ZIP 02501 TEL 508-790-2887 FAX 508-771-9696 CELLI 508-735-9993 (EMAIL info©bourqueheatingandcooling.cam abt . / ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 /1 //�tt /1� FEE: $ PERMIT# 0/r (/c#2/6j (u�/ ELAN REVIEW NOTES /� (,.2