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Home My WebLink AboutBLDG-19-002943 i -� ' ,141\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 14.11 CITY West Yarmouth I MA DATE 10/30/2018 1 PERMIT# OAP&II'©0 11 JOBSITE ADDRESS 26 Hidden Acres I OWNER'S NAME Orain Hall OWNER ADDRESS same I TEL IFAX _J TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: ._. RENOVATION: _,J REPLACEMENT: PLANS SUBMITTED: YES❑ NO APPLIANCES 1 FLOORS- BSM 1 2 13 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS - MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _ TEST i - -1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 ; _ OTHER TA'(Y\'IV1 UhQIK INSURANCE COVERAGE 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 j OTHER TYPE INDEMNITY BOND 't,._... 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 _t 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 compliance with all Tygu Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j /n i PLUMBER-GASFITTER NAME e S Reed LICENSE# 15200 I SIGNATURE MP 0 MGF❑ JP❑ JGF❑ LPG!® CORPORATION❑#L J PARTNERSHIP❑# LLC Q# 4047C COMPANY NAME:1 Coastal Mechanical ADDRESS 299 Whites Path CITY South Yarmouth STATE MA ZIP 02664 ITEL 508-737-8747 FAX 51 08-760-5800 ] CELL 508-246-9959 EMAIL lisa@coastalphc.com j SOUTH SHORE HEATING & COOLING, INC.57 White's Path � 1 SERVICE WORK ORDER SOUTH YARMOUTH, MASSACHUSETTS 02664 �� ) Il r S 75720 i (508)398-6901 l 0 ID# BILL TO 14 POLICY EQUIP. EQUIP. NOTES KEY NAME DATE / BOILER CONDENSING FURNACE Id�/ jfo METHOD OF PAYMENT GAS OR OIL UNIT GAS OR OIL STRE c I ` a j , DAT ORDER��bb `J►j�f/-�_j COD Charge Replaced Unit Replaced Unit Replaced Unit CITY PROMISED Replaced pcMaWetd,j�y Cash Check Cleaned Cleaned Compressor PHONE CALL BEFORE ❑ A.M. • ❑ P.M. Previous Service Calls Draft Over Fire Oiled Motor Draft Over Fire TECHNICIAN ;' AUTHORIZED BY �� Draft Breech Changed Motor Draft Breech WORK TO BE PERFORMED / i Smoke Checked Charge Smoke /�P_�lfieE L4e�' /Yf0�r�✓' (/� CO 2 Add Freon CO 2 Qty. MATERIALS DESCRIPTION OF WORK DONE Net Stack Cleaned Coils Net Stack 7-44 Efficiency Repaired Leak Efficiency ,.,r r Replaced Replaced �Vl1� Ve414-t h> Smoke Pipe Replaced Fuse Smoke Pipe f / Replaced g Replaced a^'��y-- aT vD 7Y) Repaired Wiring Thermocouple J / C4 i�a p; FAr/14ri7ump Pressure ReplacedContactor Pump Pressure t�, f�// // eplaced Checked Replaced ale /0 3.$to t.ofroCi PP iiCfm,c,:il Strainer Contactor Oil Strainer �•: 'Oiled Replaced Relay Check /? id? ifaCsr, 'Viol J : // � Circulator Fan/Limit 1 / p c Replaced Replaced Replaced Tt/i(h LF 6i7S [ 4 Circulator Capacitor Gas Valve Replaced Suction Cleaned Burners c, ()reed 7-4//h/h, Gas Valve Checked Head Changed Motor /'7 74../n �%�'� e'ley Ignitor jl Primary TR Cleaned Blower r a,1 i ., con ry14 de Control 1 ENVIRONMENTAL CHECK LIST f RECOMMENDATIONS CONDENSATE DRAIN Volts Lit Pilot WORK PERFORMED QTY. TYPE/DISPOSITION /� j Checked Drain Amps Repaired `�y 7 fl • Wiring C RECOVERED / EVAPORATOR Replaced ❑RECYCLED Cleaned Drain COIL Transformer ❑RECLAIMED Ro-,, Mine ir d 4 Sony 5�Q T Checked Pump Replaced Unit Checked Ignitor ❑RETURNED Tel Checked 0 DISPOSAL ik;h� ..- c o'V,VAS Replaced Pump Repaired leak Primary Control 0 DISMANTLED TOTAL a 77T - ` /7 - rl Check/Clean Pan Seal HUMIDIFIER ❑CHANGED OUT/REPLACED LIMITED WARRANTY: All materials, parts and Replaced Cleaned TERMS equipment are warranted by the manufacturers'or Exp.Valve suppliers'written warranty only.All labor performed Cleaned Coil Replaced Pad by the above named company is warranted for 60 OUR TERMS ARE NET 15 DAYS days or as otherwise indicated in writing.The above Replaced PVC Check Float named company makes no other warranties, &Auto Feed express or implied,and its agents or technicians are Ent.Temp. Adjust I have authority to order the work outlined above which has been satisfactorily completed.I agree that not authorized to make any such warranties on Water Level Seller retains title to equipment/materials furnished until final payment is made.If payment is not made behalf of above named company. as agreed,Seller can remove said equipmenVmaterials at Seller's expense.Any damage resulting from Leaving Temp. Checked Motor said removal shall not be the responsibility of Seller. ❑REGULAR ❑WARRANTY T.D. ❑SERVICE CONTRACT ((��/�//n-� jn� FILTERS F?Cleaned ❑Replaced J CUSTOMER SIGNATURE DATE /LQYL/<(YOU a � ;_ (. -_,� L-,.-.,' -•..- •-.. ,•.--_.---',.;4--•-.- ' ,,.2- -''..:'''---,0.7',., -----.--'''''- . • '''''.;-• '''''-•..r ik, .;:„,,,,,:....„ ,,21,.-f,katilir--.4„:•••_•-•--•7:1„t---.44,t--.---Y,A,.:-.,''-,r-- --- .-.4-?- ••X:L.) :-li,--... • 1 sl +a -. =L� � ;- ' #- I TS ? �f.X' x _ ._ ��i 7. 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