HomeMy WebLinkAboutBLDG-18-000335 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -
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Yarmouth MA DATE! 07/14/17 PERMIT# /96-"V �aJ ' \
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JOBSITE ADDRESS 1 94 Stratford Lane �;OWNER'S NAME L_ YarmouthportMA , ,,y ,,,,__ia
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OWNER ADDRESS l same TEL fAX 1
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TYPE OR OCCUPANCY TYPE COMMERCIALd. EDUCATIONAL RESIDENTIAL
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CLEARLY NEW:[J RENOVATION: I
a,Mwl _ REPLACEMENT:)� PLANS SUBMITTED: YES�-�,, NO��,
APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 - 9 10 11 12 13 14
BOILER -
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BOOSTER ;—__. 9 i Ill 'i t E i----a 1 r I ,' i I 1 ,I I:
CONVERSION BURNER i i„„i-_i �1, . ,.!AI-__-.7.!____..-� ._ I' �,. 1__ 'I�,_ 5i i _ ,�.-,,._-___�
COOK STOVE t l ,'. I '1 I .—ii ! i t r
DIRECT VENT HEATER 1 r fi r - IIF. I 71 71 I
DRYER S Ii r
FIREPLACE (,-.._. I ''l
FRYOLATOR a —' "
FURNACE?, I 1. I J"- _ 11
GENERATOR __. .7.i
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GRILLE
1 19 __...._'i __.._—It„.. . :�1._.._.. I, _.. -_ --r-- t,t _7 ,;I.. !I _. `I_____.;' ....--a
INFRARED HEATER Ir VI. " � '� "
LABORATORY COCKS ' r _..,�1
MAKEUP AIR UNIT 1,, ' I ( I
OVEN -r Ji' Ill l i �1i 1 . __m "! _�' 1 G
POOL HEATER 1_..� ,I I 1---11 I— • 1
ROOM/SPACE HEATER �l �I i' `I a.,.... I._ __ i t
ROOF TOP UNIT
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TEST ,_,...,_ ': __..�I._._ -_..,,`_ .._; ! .. . �.._r r.__ , L, <.r, ' 1 — >
UNIT HEATER ,....._. :�...... .'i__ _...'—'— — J l.__......
IL�_ 1 l ._..__.I_.... ..:
UNVENTED ROOM HEATER I , r"----'i
WATER HEATER I'# - T r— ➢ !
OTHER i i7_..._ :L--_ L. __..L __._.._.I..-----?r... .. .1 ___ ------_. L__._ ;7.1..11__Tit__ _ _ _r, _-_ ,
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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 -z NO f,,
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY j '1 OTHER TYPE INDEMNITY `-, BOND377
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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 IT S AGENT T
SIGNATURE OF OWNER OR AGENT
l 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 compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Ce.--) 0 ir-- ------ --2
PLUMBER-GASFITTER NAME[Crai BishoE. t LICENSE#`15101 A SIGNATURE
MP e ,,;- MGF I .." JP _] JGF LPGI CORPORATION'S#'i PARTNERSHIP';,,; # _ F' LLC fI#I ,,
COMPANY NAME-iHiah Efficiency ADDRESS 1378 route 130 E
CITY Sandwich L,,
STATE' Ma ZIP 102563 TEL ___—,; _
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FAX CELL! l4EMAIL'admin hi h-effcienc Ilc.com
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