HomeMy WebLinkAboutBLDP&G-18-003037 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
;_ CITY Yl1 �r, .IV-11,. MA DATE l i I' 1 '-' I PERMIT# ✓/"If''0d _•
4.A JOBSITE ADDRESS LA, JV �(bi I+ ''L E OWNER'S NAME 1 T)i )7,tcUr'
POWNER ADDRESS C I TELL (-2-12-6S`11FAX,
TYPE OR OCCUPANCY TYPE COMMERCIAL Ij EDUCATIONAL ® RESIDENTIAL l"
PRINT
CLEARLY NEW:® RENOVATION:® REPLACEMENT: i- " PLANS SUBMITTED: YES® NOD-
FIXTURES-1 FLOOR- = 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1IW W'.1
CROSS CONNECTION DEVICE . , II• iantingsm',—.
DEDICATED SPECIAL WASTE SYSTEM MIMIIIIII NM ; -M1 _ ._, . ....
DEDICATED GAS/OIL/SAND SYSTEM ;I ', ; ! __,_.
DEDICATED GREASE SYSTEM mom mummonicomoscomontomounow um Nil
DEDICATED GRAY WATER SYSTEMWI1fI1II ;1W „•..a_.,
L DEDICATED WATER RECYCLE SYSTEM _Il .M I„ _ _ — I _ 1
DISHWASHER _III -. II MI
DRINKING FOUNTAIN � IQ , �i�llll_MIIM .�
FOOD DISPOSER II _r I_iIWi I ,M ; -i
FLOOR/AREA DRAIN MITI ,, [ M_ ._:
INTERCEPTOR(INTERIOR) -I IM 'WNW WNW PM i
KITCHEN SINK I .I1I II WWI
LAVATORY _I__' I I II��. � WM
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SHOWER STALL I I I, INIM --� I
SERVICE!MOP SINK I l I�I I II I I ��_R IL I
TOILET - — MiWNW 1111100/M�_
URINAL =: L U , :•— I�lr.�1{II I ,II.I
STIMBISII WASHING MACHINE CONNECTION I 'j. _ I � ;
WATER HEATER ALL TYPES MI I—I I, 11111. ;INN WEMIIII.t.
WATER PIPING MM.I I II IWIMI iE I I_LM:_
OTHERL. MINX I „I _., 1II1� �I_ :I_..
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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 Li NO LI
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF 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 t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance all P t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R PETER CHECKOWAY LICENSE# 13417 TURE
MP J JP® CORPORATION O# 4008 'PARTNERSHIP®# LLC-# ,
COMPANY NAME BOURQUE HEATING&COOLING CO I ADDRESS 1199 PITCHERS WAY
CITY HYANNIS STATE' MA 1 ZIP 02631 TEL 508-790-2887
FAX 508-771-9696 1 CELL 508-735-9993 I EMAIL info@bourgeheatingandcooling.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
•
1
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-% tl f' CITY t ,r, ',./; , ,' - _.. / MA DATE li/ 7/17 1 PERMIT#A D/7/ d'
JOBSITE ADDRESS + ' _, f;', '1'n. i, '\_ 'OWNER'S NAME 1 --iCt' 12)✓' 'J'kft'
GOWNER ADDRESS ti j ,,t,- /TEL 77`1-Zi—6.7y9.1FAX[ i
TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL D RESIDENTIAL(
PRINT
CLEARLY NEW:D RENOVATION:0 REPLACEMENT:Ld PLANS SUBMITTED: YES LI NOD
APPLIANCES-1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER MIL , I I
BOOSTER I�'i�y ,I I _.
CONVERSION BURNER 111111111 ,111111 M awl
COOK STOVE I _ I 1 ,
DIRECT VENT HEATER 1' i' 1
DRYER I i I I 1 1 ,
FIREPLACE 111111� r
FRYOLATOR , llgi 11‘ ni_ . i !
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FURNACE r ��_ l' i
GENERATOR '
GRILLE +ii , _
INFRARED HEATERMIMIMIMI' 5, i
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LABORATORY COCKS MI 11111111:=1
MAKEUP AIR UNIT ii 1 1` "NI i ? I I 1' ,�,�
OVEN IltalOIKIIIMIIMIIIII IMEMINIt W.-
POOL HEATER RRRRRRRRRRRRRRROOM1SPACE HEATER
ROOF TOP UNIT � 1 _ i �
TEST ii,
UNIT HEATER MO: RI
UNVENTED ROOM HEATER air, 1i
WATER HEATER ; _ i „ '` r '
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OTHER �`�I�i� �r�MIIIMME .,........,,.�.....����
IMIIIIIII"MIMM
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1 IWLJI 1 A to r r r- _ '
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL,Ch.142 YES 0 NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY "Lf,j 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 D AGENT Imo'
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. : test of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliant-with all •- ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME R.PETER CHECKOWAY /LICENSE#1 13417 / NATURE
MP I_J MGF Li JP Ll JGF L.j LPGI® CORPORATION( # 4008 /PARTNERSHIP D# / LLC[J#
COMPANY NAME: BOURQUE HEATING&COOLING CO 1 ADDRESS 1199 PITCHERS WAY 1
CITY t HYANNIS / STATE MA ZIP!02601 /TEL 508-790-2887 1
FAX 508-771-9696 ' 1 CELL 508-735-9993 'EMAIL info@bourqueheatingandcooling.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 ❑ ❑
_ FEE: $ PERMIT# _
PLAN REVIEW NOTES
1