HomeMy WebLinkAboutBLDG-17-004247 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
�spars CITY YARMOUTH PORT MA DATE I 2/13/17 1 PERMIT# --d ''/'7"110YA-y7
JOBSITE ADDRESS; 13 WILLOW STREET I OWNER'S NAME I JUST PICKED(BACK BUILDING) 1
GOWNER ADDRESS i 13 WILLOW STREET I TEO FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL;
PRINT EDUCATIONAL D RESIDENTIAL
CLEARLY NEW: RENOVATION:jj REPLACEMENT:0 PLANS SUBMITTED: YES® NOD
APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I
BOOSTER
CONVERSION BURNER ,.
COOK STOVEIsirai I,
DIRECT VENT HEATER " � 1 1
DRYER ..
FIREPLACE ,-_
1
FRYOLATOR :z z. �._ F
FURNACE ( 1 1 atti
GENERATOR
GRILLE _ �_
� , .
INFRARED HEATER , _.. ii i
LABORATORY COCKS
MAKEUP AIR UNIT � � � ��
OVEN �. _ ,� _,. . �,,. v
�_ a ..m,
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POOL HEATER
ROOM/SPACE HEATERdo.
ROOF TOP UNIT
� TEST 1
UNIT HEATER 1` „r ,, i
UNVENTED ROOM HEATER �'
WATER HEATER ��
OTHER ,_ Z
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L,11 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 Lj
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 11_j ! 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 c pliance with all Pert. ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER 1 LICENSE# 3880 4 G TURE
MP J MGF JP" JGF' - LPGI® CORPORATION i # 173 PARTNERSHIP #- LLC®#I ,__ ]
COMPANY NAME:; ROBIES HEATING&COOLING ADDRESS 279 YARMOUTH RD
CITY HYANNIS STATE MA ZIP!02601 JITEL 508-775-3083
A
FAX 508-534-1272 CELL' 774-836-5659 EMAIL MARY ROBIES.COM
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑4ii3
FEE: $ PERMIT# /1/(7
PLAN REVIEW NOTES C'�