HomeMy WebLinkAboutBLDG-19-001189 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-•=_i-y'; CITY j 1 MA DATE i 5u I PERMIT#/'IO6�/DU�l
JOBSITE ADDRESS 7 k, i iv Ji (7( v-( k. 1 OWNER'S NAME N�i I S , V C '?^ 1
GOWNER ADDRESS bt) ',{'f,v/ (,i"1 JJ,0f nV ]C'L !TE `-I S -Y:PejL'I1FAXI, 1
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL D RESIDENTIAL a(
PRINT ,-�/
CLEARLY NEW:I[J RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES D NO27
APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1�.BOOSTER . ...
, .. II------.1 1 x. �, ,_ ��. ..?•^ i r.-.W,.�i'-.. . '! . .i
CONVERSION BURNER 1 I II tl ;: :- t
COOK STOVE _. i MIK_ ii - --II f i i
DIRECT VENT HEATER _-.... I. ,.__._ _ .__ -DRYER ma �. ` _ I ; m
- .._.[." ' _ _W ..�..E°
FIREPLACE �
FRYOLATOR 1 i I it II @� t_ I; '�'€ t.
FURNACE 1. 1. ° :',7---,,t
GENERATOR I is 1 .I ,.. f� 1
GRILLE I It d=i Ii L f ► ' El II_..-....-I! , ..i
INFRARED HEATER ( I;��1 _ li 61 I 1 ��i , ii _.., 1 7 t
LABORATORY COCKS r
MAKEUP AIR UNIT 1 11 _ a: _ y.z i 11 1..1. 6 1 M,m s�-^^
v,
OVEN I:MI� r t ' 1 E�...�
� POOL HEATER � i�� �; ..e.. _._... ,_ --ROOM I SPACE HEATER 1 I y.- I m . , L. t; r ii ti
ROOF TOP UNIT .
TEST _' - i— . I ! `
M UNIT HEATER 11 1 .J ,1111111111111101 M . I
UNVENTED ROOM HEATER 1 _ I' .._.' g i i, J ji I
I=
WATER HEATER ; _...' -_ opt- , 1--I Ir
OTHER __ � i —
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ill NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY J BOND U
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 or the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 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 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 `LICENSE#1 13417 1 NATURE
at -
MP ILi MGF Li JP ID JGF J LPGI Li CORPORATION jj# 4008 1 PARTNERSHIP�# i LLC(_J#
COMPANY NAME:,.BOURQUE HEATING&COOLING CO ADDRESS 1199 PITCHERS WAY _ _
CITY HYANNIS I STATE MA ZIP!02601 ITEL 508-790-2887 1
FAX 508-771-9696 " CELLII508-735-9993 'EMAIL info@bourqueheatingandcooling.com
c: fhi
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