HomeMy WebLinkAboutBLDG-17-001437 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
a ti= CITY SOUTH YARMOUTH I MA DATE 9/16/16 I PERMIT#F -s)b-/7-00//I3)
JOBSITE ADDRESS 48 MONOMOY RD OWNER'S NAME CHLUDENSKI
GOWNER ADDRESS `48 MONOMOY RD TEL 508-498 5710 'FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL A EDUCATIONAL J RESIDENTIAL,
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CLEARLY NEW: iril RENOVATION: REPLACEMENT:D PLANS SUBMITTED: YES D NO':
APPLIANCES Z FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ._
BOOSTER °e ,
CONVERSION BURNER i �' "
COOK STOVE _ d�
_DIRECT VENT HEATER ��
DRYER
FIREPLACE � �� L
FRYOLATOR I
FURNACE 1 i
—
GENERATOR .' _.
GRILLE —
r
i
INFRARED HEATER
it _ _f—,
LABORATORY COCKS
MAKEUP AIR UNIT L
OVEN 1,. �,:
POOL HEATER �
;-
ROOM/SPACE HEATER 1
o
y1
ROOF TOP UNIT 1�._
TEST �_ _ _ i.
UNIT HEATER 1,�, s
UNVENTED ROOM HEATER v„
WATER HEATER
OTHER
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.
INSURANCE COVERAG � ���E
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 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 accurate to th best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be' compliance wit all Pe ' ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. aJ
PLUMBER-GASFITTER NAME ADAM TRAYNER I LICENSE# 3880 G TURE
MP 1 MGF I� JP J JGF J LPG!_ CORPORATION 0# 173 ' PARTNERSHIP 0#3 ' LLC #
COMPANY NAME: ROBIES HEATING&COOLING I ADDRESS;279 YARMOUTH RD
CITY HYANNIS STATE I MA ZIP 02601 TEL'508-775-3083
FAX 508-534-1272 CELL 774-836-5659 I EMAILI / . C Q an
SEP 1 �06
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES