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HomeMy WebLinkAboutBLDG-19-003603 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'i " CITY W YARMOUTH MA DATE 11/7/18� "e" PERMIT#� � ��� ?�Og JOBSITE ADDRESS 41 IROQUOIS BLVD. OWNER'S NAME ABBER GOWNER ADDRESS 41 IROQUOIS BLVD. TEL 978-973-6168 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL J PRINT CLEARLY NEW: """ RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES _ NO APPLIANCES Z FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE m �" s. � �- � _ ". FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER . _ „ , " _ m� _ _ _ _ - , e LABORATORY COCKS m ",,, �. �" �._ _ nm MAKEUP AIR UNIT __ _„ OVEN __ . _� .._, ", " a� " POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT . TEST _ _ � ..�" , "�,� � _ _.. UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _._ OTHER ATTIC FURNACE 1 _ ` e -a _ "a m "_- � � e _�. � 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 i 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 li nce with all '/-rtin provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I � N PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE# 3880 SIG AT E MP MGF i JP JGF LPGI CORPORATION i # 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 508-75-3083 EMAIL MARY@ROBIES.COM $ &Jr?) Li? i_i. ROUGH (.AS INSPECTION NOTES THIS PACE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES