HomeMy WebLinkAboutBLDG-20-001478 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
='!' YARMOUTH 9/16/19
;V CITY MA DATE PERMIT# GAP'o (2) (Y a
JOBSITE ADDRESS 1200 ROUTE 28 LAMONICA
OWNER'S NAME
GOWNER ADDRESS TEL 508-619-3367 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑� EDUCATIONAL El 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 1
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
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 ❑■ 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 applicatio are true and accura to a best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in liance with a nent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME DOUG LANGTRY LICENSE# 11305 SI ATURE
MP❑■ MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION❑# PARTNERSHIP El# LLC # 3081
COMPANY NAME AQUA SERVICES PLUMBING &HEATING ADDRESS 1200 ROUTE 28
CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367
FAX 774-470-1351 CELL EMAIL DOUG-AQUA@COMCAST.NET
7 ti
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
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7//7 7? PLAN REVIEW NOTES ���(i � v 7//1-9
Presscision PPT Test Report
Test Status:
PASS
Test Date/time:
2019/09/17 09:06 AM
Test Personnel & Company:
Doug Clingan
Aqua Services •
Test Location:
1200 Route 28
South Yarmouth, MA 02664 •
Test Notes:
Test Type: Fuel Gas •
Test Media: Gas
Test Duration (hr:min): 00:10
Pressure data (psig):
Note:negative is pressure drop
Start: 9.1
End: 9.1
Change: 0.0
Temperature data (deg F):
Note:negative is temp. drop
Start: 66.4
End: 65.6
Change: -0.8
Record #: 6
Test Instrument Details
Presscision Instrument
Model #: ppt01
Base SN: 60011729001002
Pod Model #: ppt01-pod-pt015g
Pod SN: P0011729050001
Cal date: 2019/05/09
Software Version: 1.4.01