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Home My WebLink AboutBLDP&G-20-001205 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK fft CITY. U Vit e'A 1 'f I MA DATE Q.I /GJ I PERMIT -CV JOBSITE ADDRESS �•� �l aN kCto 6 ��11 g6( € OWNER'S NAME -rr-AY� I (-!�Gi,1►/(e I.\ j r• , OWNER ADDRESS ?Cl S r-1.4, /VI t �w lt7 , C ] TEL, eE o '•�!7i�`-/-119 AX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL a PRINT CLEARLY NEW.❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NQI:2' FIXTURES Z FLOOR-' BSM 1 2 3 4 , 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I : { DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ A J [ 1 DISHWASHER DRINKING FOUNTAIN I I I Ii FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY I l ROOF DRAIN SHOWER STALL SERVICE l MOP SINK j: �I i TOILET URINAL WASHING MACHINE CONNECTION i I I p WATER HEATER ALL TYPES WATER PIPING ) I OTHER 0 INSURANCE COVERAGE: liability insurance policyor its substantialequivalent which meets the requirements of MGL Ch.142. YES NO I have a current ab v q ❑ ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ® BOND CO 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 t t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance 'th all P i t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R PETER CHECKOWAY LICENSE# 13417 URE MP 0 JP❑ CORPORATION❑# 4008 PARTNERSHIP❑# LLC❑# COMPANY NAME BOURQUE HEATING&COOLING CO ,ADDRESS 1199 PITCHERS WAY CITY HYANNIS I STATE MA 1 ZIP 02631 TEL 508-790-2887 FAX 508-771-9696 1 CELL 508-735-9993 EMAIL info@bourgeheatingandcooling.com a`/ ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El El FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , \i �� `9/Z / f`/ ,./�� / CITY )()ill//\ fT y1 � MA DATE $ PERMIT# JOBSITE ADDRESS i( S 1 I GI L ba,I/1 1; �j I OWNER'S NAME' \ a e.-K•Tv-, GOWNER ADDRESS 7`js ThjrAgA wiLl-crtrywo 1 r TEL !. FAXI TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL U RESIDENTIAL IV- PRINT CLEARLY NEW:[J RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES U NO APPLIANCES 7 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 ! , BOOSTER :1 �: . I �� CONVERSION BURNER '�d� ?. 'I '�,1 IO COOK STOVE Mit ENE DIRECT VENT HEATER FIREPLACE MgM'Mnff • • •• �I tip _,._ ,-OEM FURNACE W In n GENERATOR INFRARED HEATER =r-11l LABORATORY COCKS MK 1, Ij MAKEUP AR UNIT UM" . :.-, i- I 11 OVEN 11 POOL HEATER ; ; ROOM /SPACE HEATER _ . . . AL.. _ _ ROOF TOP UNIT TEST UNIT HEATER ` awuuauuu UNVENTED ••• 1� I _ 7 or ; .. HEATERWATER . i . _ . OTHER ' «®�_� 3 1 i minim WM� IK1 Eng 111111=1111=-,---- _ Il3 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO EU 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 Li 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 t 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 t. .-st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian•-with all '- ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R.PETER CHECKOWAY LICENSE#I 13417 I NATURE MP LJ MGF LI JP U JGF® LPG'El CORPORATION 0# 4008 I PARTNERSHIP D# I LLC❑# COMPANY NAME: BOURQUE HEATING&COOLING CO 1 ADDRESS 1199 PITCHERS WAY CITY HYANNIS I STATE MA ZIPI02601 ITEL 508-790-2887 FAX 508-771-9696 I CELL 508-735-9993 IEMAIL info@bourqueheatingandcooling.com ROUGH GAS INSPECTION NOTE THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No _ THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES