HomeMy WebLinkAboutBLDG-17-002614 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
13- 15. .
CITY MA DATE JI ] d/ iL f PERMIT# O —/7 e4h'
JOBSITE ADDRESS 1S U V twK4'/ eti-Cc ��'�� I OWNERS NAME !1/I ( D✓��•
GOWNER ADDRESS _ ����� ITEL 6(7- a 46 -7[-,�( FAXi _ 1
TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL rj RESIDENTIAL
PRINT
CLEARLY NEW:J RENOVATION:® REPLACEMENT:E PLANS SUBMITTED: YES r NO1
APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1 ,. I 1__..., '[- _;
BOOSTER _ 1E I... _..n ii l l.... . . _...,..
CONVERSION BURNER 1 ( Ii W
r .i, m
COOK STOVE
DIRECT VENT HEATER [._._....I . _....._II.=.0 _ ±'_ I) 1,- _. i_ l
DRYER i I
FIREPLACE a
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FRYOLATOR ..._. j_-__�E II t, 4( k 1 I —11- I I
FURNACE rT ► Ii .__ 1 __
GENERATOR _ II _AI_hi /i , � '� I
INFRARED HEATER 1 11 i i =l 'M WI1 1-i
LABORATORY COCKS .., 7..
MAKEUP AIR UNIT ...... . ....:..__. . iiii aim[ i.iiir L J li
OVEN . , 11 i 11. :____ 6. .. e .i
POOL HEATER �__ E . .( , . I . _iLL,, . _ II_ . .. ..,.._._.__I_ . ..
ROOM I SPACE HEATER am—am � i
ROOF TOP UNIT
TEST L 1__ E( A C i 0 :r {
UNIT HEATER II-1f1.. 1= " t
UNVENTED ROOM HEATER )!— t.: MM.Mill= a, :
WATER HEATER I . 1� 11 . _l __ '..__.._......_. !_ _ _ ..__L___'____,- 1
OTHER 1 11.1111101—— ., _- 3. : ' _
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1 1 . 1 I mi' —M 1 4 '1— 1
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES -NO L
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [j OTHER TYPE INDEMNITY D 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 C'
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. : .est of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian.- with all •- ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME R.PETER CHECKOWAY I LICENSE#1 13417 NATURE
MP Li MGF Et JP 0 JGF J LPG'® CORPORATION Q# 4008 _ I PARTNERSHIP IC]# I LLC J#, I
COMPANY NAME:,BOURQUE HEATING&COOLING CO I ADDRESS j 1199 PITCHERS WAY I
CITY j HYANNIS I STATE MA IZIPI02601 ITEL 508-790-2887
FAX 508-771-9696 . I CELL 508-735-9993 !EMAIL info@bourqueheatingandcoolin9.com
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No A/O 5 "✓1-C',
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ �� A 4C
FEE: $ _ PERMIT#
PLAN REVIEW NOTES