HomeMy WebLinkAboutG-12-071 MASSACHUSETTS UNIFORM APPLICATION FOR A PF,pillo! L A T TO DO GAS FI G
("Mc/4, CITY/TOWN: .. rS a J STATE MA 'S1 LI w•T r N QA4E:II 7 u Al
ta gay .. LII
JOB ADDRESS:�J•�(_'!'��'iFi/YJ Am. ,n., � � AUG 0 8 2011
G OCCUPANCY TYPE: COMMERCIAL RESIDENTIAL/ PLANS LSS BM ED: YES [$ NOD
ING
NEWS ALTERATIONS REPLACEMENT�EMOVAUDEMOLITION�Y CPT
r'NATURAL& LIQUEFIED PETROLEUM GAS: PIPING-EQUIPMENT—APPLIANCES—SYSTEMS 1
ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FIVE(5)NUMERALS
AIR ROTATION UNIT J ( FURNACE: ALL TYPES TEMP HEATING EQUIPMENT
BOILER:ALL TYPES —I. GAS PIPING THERMAL OXIDIZER J
BOOSTER ---1. GENERATOR(STATIONARY ENGINE) TURBINE
BROILER ILLUMINATING APPLIANCE UNIT HEATER J j
BURNER: ALL TYPES INCINERATOR WATER HEATER: ALL TYPES
CO-GENERATION UNIT INDUSTRIAL AIR HANDLER EQUIPMENT OVER 12,500MBH
COFFEE ROASTER INFRARED HEATER rOTHER NOT LISTED?
COOK APPLIANCE HOUSEHOLD KILN I GLORY HOLE I CRUCIBLE
COOK APPLIANCE COMMERCIAL LABORATORY COCKS I.J
DECORATIVE APPLIANCE MAKEUP AIR UNIT I J
DIRECT VENT APPLIANCE --I MECHANICAL EXHAUST EQUIPMENT I J
DRYER: ALL TYPES OVEN: ALL TYPES I I
FIREPLACE:VENTED!UNVENTED POOL HEATER II
FRYOLATOR ROOF TOP UNIT
FUEL CELL I ROOM HEATER-VENTEDNENTLESS J
PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY
A ua Services 350 Main Street Unit ACorporation Business#
NAME: q r _ ,. a. -. 1 ADDRESS: � .
Y:[West Yarmouth STATE: MA :ZIP, 02873 J Partnership Business#
CIT
....�,,.�,.,,,,...�,,,,.,.,m,..,,,.M.,.,n� 3081
( _ _ _ LLC Business#
TEL J 774-470 1350 ,J FAX: ,. EMAIL: doug-aqua@comcast.net e
- -•� El DBA/Unincorporated
NAME OF LICENSED PLUMBER!GAS FITTER: Doug Langtry
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ID NO El
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Ei Other type of indemnity D 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 0
Signature of Owner 1.oorrOOwner's
Agent n
OWNER'S NAME: E' ,.,,,..,C. St'
�GeANCG, . J TEL:Zrz:34Q2.'3. — FAX ----.—,.....---I
I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to
the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with
all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the General Laws.
(OFFICE USE ONLY) Type of License:
Permit# __ 2— — 0 k ❑✓ Plumber OGasfitter
�t cif
ur o ice ed Plumber!Gas Fitter
Inspector 'unlit �1 ❑✓ Master ❑Journeyman 11 i
F ❑Undiluted LP Installer License Number: 0-1-305 !
Fee:
0 Limited LP Installer
ti
ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT#
PLAN REVIEW NOTES