HomeMy WebLinkAboutG-14-914 •
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. . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORKnalirM
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`tAilf- / CITY West Yarmouth MA DATE 4-14-14 PERMIT#
JOBSITE ADDRESS 6 Alden Rd -29/169/3677 OWNER'S NAME Bob Kavey
GOWNER ADDRESS 31 Sparthiil St-Waltham 02452 TEL 771-7617/781-899-5786 IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONALRESIDENTIAL❑ •
PRINT ❑
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:a i PLANS SUBMITTED: YES❑ NOD
APPLIANCES? FLOORS-. BSM 1 2 3 4 5 6 7 B 9 10 11 12 13- 14
BOILER
BOOSTER •
CONVERSION BURNER I . • I
COOK STOVE r
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
- FURNACE I —
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT iiiiiiinvelossin
OVEN
POOL HEATER •
TEST .
UNIT HEATER
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APR t fi 7[114
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BUILDING D9 ENT INSURANCE COVERAGE
I ayR a currentlia6it't , E.. . ..Iicy or Its substantial equivalent which meets the requirements of MGL Ch.142 r` YES I I NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q • 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 ,
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CHECK ONE ONLY: ' OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and ecarate t• --f my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with/CJI P sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.•
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PLUMBER-GASFITTER NAME Kevin Saunders LICENSE#4546 lIGN
MP❑ MGF EI; JP❑ JGF❑ LPG!❑ CORPORATION❑# , PARTNERS • ea# LLC all
COMPANY NAME:Seaside Gas Service Inc ADDRESS 167 Helmsman Dr
CITY , Yarmouth Port STATE MA ZIP 02675 r TEL 508-771-2768
FAX ; CELL 508-400-0943 EMAIL seasidegas@comcastnet
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY ' - FINAL INSPECTION NOTES ..
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. . . THIS APPLICATION SERVES AS THE PERMIT' 0 0
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FEE: $ , • PERMIT# • . ,' , ,
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PLAN REVIEW NOTES
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