HomeMy WebLinkAboutG-19-2735 1 r
` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
3A_ CITY I SOUTH YARMOUTH I MA DATE; 10/24!18PERMIT#
JOBSITE ADDRESS'32 GREEN WAY I OWNER'S NAME FEINSTEIN
GOWNER ADDRESS ;32 GREEN WAY I TEL'703-999-8788 FAX'
TYPE OR OCCUPANCY TYPE COMMERCIAL U EDUCATIONAL❑ RESIDENTIAL'.0
PRINT
CLEARLY NEW:Ia RENOVATION:❑ REPLACEMENT:rJ PLANS SUBMITTED: YES J NO
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER 1 " I r'
COOK STOVE __
DIRECT VENT HEATER "
DRYER I — __.
FIREPLACE
FRYOLATOR
FURNACE T '
_1,...1):
,�._ ._._.._ ._...�. --- ,..._T — T_ ter. ___,_ .- '.__._._.. ____ — —"— r___
GENERATOR V ' �
GRILLE
INFRARED HEATER �� � _" —_— _
_ .__ __ �.: ____ __ _. .._'_._.-.` _ ! _ _____ _.— ._ : ___
LABORATORY COCKS •, i
MAKEUP AIR UNIT " i
---- _._ .T-- —- --- — — —F.-- —
OVEN
POOL HEATERi
ROOM I SPACE HEATER _. — — x __ _
r ®� _�
ROOF TOP UNIT
TEST Q_
UNIT HEATER I
UNVENTED ROOM HEATER
WATER HEATER -
OTHER
•
INSURANCE COVERAGE ' 7 ___ _�
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 VIES'Ed NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY a OTHER TYPE INDEMNITY ❑ BOND 0
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 J AGENT 'El
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 st of my knowledge
and that all plumbing work and installations performed under the permit issued for this applicationwillwith a Penin t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ?compliance
PLUMBER-GASFITTER NAME!ADAM TRAYNER 1 LICENSE# 3880 S NATURE
MP',._.1 MGFJP D JGFU LPGI CORPORATION rjl#! 173 I PARTNERSHIP J# ILLC'J#' i
COMPANY NAME:''ROBIES HEATING 8 COOLING ADDRESS' 279 YARMOUTH RD 1
CITY I HYANNIS 1 STATE MA 1 ZIP;02601— ---ITEL 508-775-3083 T 1
FAX 508-534-1272 I CELL 508-775-3083 IEMAILrMARY@ROBIES.COM
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
pth(i6, ,, iYes No
o� THIS APPLICATION SERVES AS THE PERMIT 0 0 $
Q 7 FEE: $ PERMIT# 1114 IC;"
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