HomeMy WebLinkAboutBldg-19-006963 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
411- CITY WEST YARMOUTH I MA DATE 6/05/19,_.. ...._._ PERMIT# / b"19-o0 9
JOBSITE ADDRESS 21 COTTAGE DRIVE OWNER'S NAME PALMERI
GOWNER ADDRESS 21 COTTAGE DRIVE mm ` TEL 781-738-5106 'FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: _ RENOVATION: .__ REPLACEMENT: . PLANS SUBMITTED: YES NO
APPLIANCES 7 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER 1 ` I
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
i
DRYER
FIREPLACE I
FRYOLATOR
FURNACE 1 »_» �a» _., �_. _._.A r
GENERATOR
GRILLE
INFRARED HEATER I .__ I _ __ ._ _w
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT »___
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I/ NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY : 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 ._..'
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 pliance with II Pe " ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE# 3880 IGNA URE
MP . MGF JP JGF LPG! ; CORPORATION �s# 173 PARTNERSHIP # LLC
COMPANY NAME: ROBIES HEATING&COOLING ADDRESS 279 YARMOUTH RD
CITY HYANNIS STATE MA ZIP 02601 TEL 508-775-3083
FAX 508-534-1272 CELL 508 775 3083 EMAIL MARY@ROBIES.COM
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
, FEE: $ PERMIT# -c" 1/44 T5 l
`—PLAN REVIEW NOTES /Phi 7 &