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HomeMy WebLinkAboutBLDG-15-000456 ai'• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "Ni= 1 CITY YARMOUTHPORT ' MA DATE 08108/2014 PERMIT# as `itheIa► M $ JOBSITE ADDRESS 115 Merchant Ave OWNER'S NAME Cheryl Bumham Q \J OWNER ADDRESS Same TEL (FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL El PRINT M CLEARLY NEW:ED RENOVATION:El REPLACEMENT:01 PLANS SUBMITTED: YES ID NOE APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 t BOILER I I , , 1 1 I -- _I _ I I5_ _ m_ _ ____ 1 __ BOOSTER J'_J �_ �� _J __) \ CONVERSION BURNER + 1 _1 1 _1 I _1 iI I kECOOK STOVE _ DIRECT VENT HEATER _I __J _ J _ I__I DRYER 1 I_J a1' ____I ___I FIREPLACE __,i I __,_ I _•_J_1 __ _I .•_.J __J _I _J ___I _J ._I FRYOLATOR 1.____I __I I 1 --j , _ 1 _1 __J'___„I ,...,.,J _,,J _ ,...I — J I FURNACE '—J'—J _. I .... .j _J _J 1 ._...J I I _-J ._I _._... 1 I ____! . GENERATOR ,.___.3 _,__ ___ I _I I J.__1 —I __T I J I I_,___1 _.1 i . _I GRILLE i._ .I __J .._ I ---I _ J _J _ _!'_J'_ I _J ___1'._,_J ' __�_ 1 I INFRARED HEATER 1, 1 ___I __I J _ . I_ I I .r-J —1 ._, 1 ,I _ .I _ ___JLABORATORY COCKS I _. __.. ___ I _ _ _ I ...._ I 1 I I MAKEUP AIR UNIT I _ .__J ,J _1_1 -J .TJ J _____J 1 __ . I r J I I w� I .. I OVEN _J 1 J ___J ,___J.__ ___„__J .._.J'-1 _-_r),—J _! _tel ! _I POOL HEATER I _TI_J __J_J ___J I __J J _I __I'_I __,J —1 _._J ROOM/SPACE HEATER i^_I I ^J __J ^J _____I_ _J J'_—f _l ,__J _—J _J'11 I ROOF TOP UNIT I J11 __J I I ___1 1 i,. -J --I I TEST I__J iJ J __I __J I ,_1 _I ._..._I I J _J UNIT HEATER .1 • I ,._J ____J L_LI'_._1'_._I _J I__I __J -,_ „J - I uNvEtTE at aT _J ._._J ,_ _I .�J _J 1 J -..J -J _J __J -1 _I WA-ERH TER I v L ® I 1 1 I I I OT ER - o (Gf— . i— —1 __J I I._ _I __I . _ I _ l 1___J __1,1 _ _J__-_J__.J —I _J _-_J _1 i _I i i ___I ®..J __I -__J __ .J ,__._I_u ._J __._I i"____!___.J'. .. _J ©y:_ _ _ ______ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY u OTHER TYPE INDEMNITY ❑ BOND Ei 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 Li 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 best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in ante with all Pertinp4 pryvision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. any (0 (j�/ -,/M PLUMBER-GASFITTER NAME Frank Roderick LICENSE 417794 SIGN URE MPU MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 1762-C PARTNERSHIP El#1 I LLC❑# COMPANY NAME: Rusty's Inc. (ADDRESS 222 Mid-Tech Drive CITY i West Yarmouth ( STATE PM-Al ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL !EMAIL WI if-