HomeMy WebLinkAboutBLDP&G-17-003822 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-:rill • CITY -/ MA DATE //?3 dQJ7 I PERMIT# 0 /" I 9 4la'R
W JOBSITE ADDRESS d-S 1 1u.61(d ,S' 44-Ci - OWNER'S NAME I' A 6%1i1/4, r,( _ C,'Y/ 1
GOWNER ADDRESS Sil lM� - 1 TEL,j) -34S- (/ j{ FAX i 1
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL €D RESIDENTIAL(� .----
PRINT
CLEARLY NEW:0 RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES[___i NO;r�
APPLIANCES Z FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER � I_ _ ._.- ' .. _ I _ :L t
BOOSTER � l[_. I __[ i_ . .1 I l 11 I
CONVERSION BURNER I ! RIM
COOK STOVE L II
DIRECT VENT HEATER ___I 7 `I_ _ uI i_ r
_DRYER I !Mr-
FIREPLACE
FRYOLATOR j�[ r - 1, 1 r i ii _ [ I t
FURNACE [ 1=E-1=1111111= i _... . I
GENERATOR I. . .. ,1 il_ tI ` .. . IAMBI
GRILLE 1 $ 1 i=i ice' • 'L.. .i
INFRARED HEATER =1 J1 I' I I= 1 I
LABORATORY COCKS ' ' i. .-1 ,
MAKEUP AIR UNIT - - iE�' Ei l — /I I
OVEN _.i ii -- '._._ 1. .. 6. _._k7 _
1.
POOL HEATER 1- ( ± `'I I1.— .11 I'. . _.t .11_ .._.
ROOM/SPACE HEATER {„...._4 --IL 1 I II ALA t[ f1._ li
ROOF TOP UNIT 1 _..... . .IL-----L.. i € it` i -_.�I
TEST L �[ . IF I) 1 � ._ -._._I! 'i
UNIT HEATER 1• __ ' . 1 i
UNVENTED ROOM HEATER 1 ..__j�
WATER HEATER 1 ' 1 L ,!
OTHER I _. gm you IJ, :�i a i .I
- - ___ . _ I[ [ II ! � -
.__.._.. _. ._. I I INSURANCE COV
ERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Fl NO t,
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 Li
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 L,,,J
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 l LICENSE#1 13417 I NATURE
MP D MGF LI JP;] JGF J LPG® CORPORATION D# 4008 I PARTNERSHIP 0# /LLC LJ#
COMPANY NAME: BOURQUE HEATING&COOLING CO I ADDRESS 1199 PITCHERS WAY !
CITY [HYANNIS I STATE MA I ZIPI 02601 ITEL 508-790-2887
FAX 508-771-9696 v I CELL 508-735-9993 !EMAIL info@bourqueheatingandcooling.com
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
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
j°=36 CITY I W SI (,O✓1 4111-1n s MA DATE 1 I-)-?Ohl 7 f PERMIT# A-a*/7 Ce 5Oa
JOBSITE ADDRESS a-3• i f a, ',t La Vlei OWNER'S NAME I Uvl�„4 RG1 f'l I
P OWNER ADDRESS! Fi GWYLC.. j TEL, ,ch g-3 YE---Lt<L5Vitx
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL Li RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES® NOE(
FIXTURES 1 FLOOR-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB --,1 ._ fI I I.w 1._ : L . ,I L_....1 ' L
CROSS CONNECTION DEVICE _. _UM: "'IMILIIMIWW.: ..... '
DEDICATED SPECIAL WASTE SYSTEM I 3 L (
,
DEDICATED GREASE SYSTEM I
DEDICATED GAS/OIUSAND SYSTEM _I I. 1[ l�L A ME����MI
DEDICATED GRAY WATER SYSTEM IL II ..:.1 � M: „. ..,,._ _ <7 _
DEDICATED WATER RECYCLE SYSTEM ,,, ;1[^ � _- _: , 1
DISHWASHER aL^-f w E . ... ,....,,
DRINKING FOUNTAIN ,,,. Mk NMI IIIIE WIIMI NM Im ;
FOOD DISPOSER IIIIIII .., _. 11111•0111111W1MILENt•—fil
FLOOR/AREA DRAIN 1IWPM 11 •I M`
INTERCEPTOR(INTERIOR) ' 11.11111111111INM I I I i Inal
KITCHEN SINK .....111M1111111.1111111.11111IMPNINFIRW,Ing WPM✓MIW
LAVATORY _T ,_ :.._ - _ H
ROOF DRAIN , _. �11 __ I
SHOWER STALL __ !RIM Y'
SERVICE/MOP SINK {- _� ._.__. t s,I . ... L
TOILET (- _ ,
l
URINAL '• ,
WASHING MACHINE CONNECTION ' PM 1.1111 MX N .M,
WATER HEATER ALL TYPES ', OMII IL �II.,
WATER PIPING t11 '
OTHER
i
. iimM, =11.111114... willigilimilliti miff.=ii.o. .imilliiii6111.0.4111roll.....Limmillilli 101.1. 1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch, 142. YES U NO Li
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING TI IE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OE INDEMNITY ® BOND Li
OWNER'S INSURANCE WAIVER:lam 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 Li
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 st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance 'h all P t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -c{
PLUMBER'S NAME R PETER CHECKOWAY LICENSE# 13417 ! �3fGDIA`fURE
MPQ JP® CORPORATION 4008 PARTNERSHIP®# ACC ILLLC0# I
COMPANY NAME BOURQUE HEATING&COOLING CO ADDRESS 1199 PITCHERS WAY
CITY HYANNIS !STATE MA l 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 El ❑
FEE: $ PERMIT# _
PLAN REVIEW NOTES _