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HomeMy WebLinkAboutG-14-1034 ' " r ' _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • _. Hit?@9VI_zt CITY YARMOUT PORT MA DATE 61312014 PERMIT# foV JOBSITE ADDRESS 170 SETUCKET RD OWNER'S NAME TIM MELIA GOWNER ADDRESS SAME-MAP 144 BLOCK 17 TEL 508-400-2228 (FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO❑ APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 ' 8 9 10 11 12 13 14 BOILER 1 4 ' - I I 1 - BOOSTER CONVERSION BURNER I I I i COOK STOVE 1 1 - 1 j DIRECT VENT HEATER — — — DRYER �` ar I I - • f 2 FIREPLACE - - 2. '- FRYOLATOR �' _ FURNACE f GENERATOR GRILLE — - - INFRARED HEATER f Y r LABORATORY COCKS MAKEUP AIR UNIT n— I m "_ '— OVEN POOL HEATER , _ ill ROOM 1 SPACE HEATER I ROOF TOP UNIT TEST - UNIT HEATER P - UNVENTED ROOM HEATER sr __ rr WP peri i!_CE r1 OT i-: tea - r — " — r JUN 9 11 .4 - Gp `fMENT INSURANCE COVERAGE I hare urrelnt nabni n urance Ra icy or its substantial equivalent which meets the requirements of MGL Ch.142 YES Q NO ❑ IIP YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POUCY Q OTHER TYPE INDEMNITY ❑ BOND 0 • OWNER'S INSURANCE WAIVER:lam 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 0 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 a..• •best of my knowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance =I • ant provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME KEVIN SAUNDERS LICENSE#4546 `'/�11...1ATURE MP❑ MGF 0 JP❑ JGF❑ LPGI 0 CORPORATION❑# PARTNERS - 74 v LLC❑# COMPANY NAME:SEASIDE GAS SERVICE INC ADDRESS 67 HELMSMAN DR CITY YARMOUTH PORT STATE MA ZIP 02675 TEL 508-771-2768 FAX CELL 508-400-0943 EMAIL SEASIDEGAS©COMCAST.NET Int) ! gia(( GC` 317F ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 • FEE: S PERMIT# PLAN REVIEW NOTES „