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_. MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK cm-17
—=1i1 ,` CITY L/f'l9f.{'> , . I' I MA DATE ,),)t' 19, I PERMIT#) f) -0014*
JOBSITE ADDRESS L C "Lk ' �ICY `' 1 OWNER'S NAME 4 rtl() \L.j'ilill^dterfi0j1
POWNER ADDRESS, rVii VIA(, i TEL qA-A •--)Ri0 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL U RESIDENTIAL
PRINT
CLEARLY NEW:® RENOVATION:® REPLACEMENT:2 PLANS SUBMITTED: YES 0 NO0
FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB i
CROSS CONNECTION DEVICE __. h... J, ,,, �.�, I., .
DEDICATED SPECIAL WASTE SYSTEM I. __ (_ _ .! . _ .__ _. .._ ,_ _....:. ......., r
DEDICATED GAS/OIUSAND SYSTEM _ ,- _ I_ ' �l
DEDICATED GREASE SYSTEM
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DEDICATED GRAY WATER SYSTEM __
DEDICATED WATER RECYCLE SYSTEM nn .•77 1,.._„t,r;- ,...f1
D►SHWASHERIW IllikiiiiifiNIIII ..: .. tr'. I
DRINKING FOUNTAIN .:.�' =.1MM` W
FOOD DISPOSER ,`
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FLOOR!AREA DRAIN I _-_I r. '_.NIK_: ...
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INTERCEPTOR INTERIOR)
� 1) I � � j ice;
KITCHEN SINK 1.111I111.1 ( iMl. .I_, e
LAVATORY T. Imo : —. W
ROOF DRAIN it : I! pff . ,
SHOWER STALL .. NM I -. PM M I 1•11''
SERVICE 1 MOP SINK I 1d _w1.1.11111111111111.1MMININSIMINI
TOILET
URINAL I 111 I ,
WASHING MACHINE CONNECTION IN __. _ , j
WATER HEATER ALL TYPES _W MR. _` (1W1 al �—•.
WATER PIPING i M ., .,_ ._ ._ . . I IUi l� l
OTHER 1 M ..-(=.--1-__JIMPIIIIIIIIIIIVIIIIMILIMINIIII
I F' .. '
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Lj NO L
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY fl BOND 0
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 DI
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 t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance 'th all P t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R PETER CHECKOWAY I LICENSE# 13417 I e/5fC3DFATURE
MPU JP® CORPORATION El# 4008 PARTNERSHIP®# ILLC0# j
COMPANY NAME BOURQUE HEATING&COOLING CO I ADDRESS 1199 PITCHERS WAY
CITY HYANNIS I STATE MA 1 ZIP 02631 TEL 508-790-2887
FAX 508-771-9696 I CELL 508-735-9993 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 4 1'
-�1um.' CITY L! f^P r111 .t�G�� _ 1 MA DATE 2 !!! (;-'L'h/e 1 PERMIT# /7 "C1C
204
rti ( /
JOBSITE ADDRESS 7,c p,A r utr. d'I ((J t' _ OWNER'S
NAME ' n1 (fh �`>> 4 r�
GOWNER ADDRESS [ 5,;Lul J TEL 5 A -6,f 7,-(5)OIFAX; a_..]
TYPE OR OCCUPANCY TYPE COMMERCIALS EDUCATIONAL (D RESIDENTIALE
PRINT
CLEARLY NEW:LJ RENOVATION:® REPLACEMENT: PLANS SUBMITTED: YES D NOFX
APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER i__ w _- _ _.. ` ._.._ I ___...R__ 1 J
BOOSTER _ I ,
CONVERSION BURNER ( _11li J` _ ;; r Mir 3` 1
COOK STOVE __ �_' _ Ir_._ , 't
DIRECT VENT HEATER
61. 6 .�W-11 , v I t
DRYER _--.IIOM—.'M`.111 , . 1 ll
FIREPLACE IPS_ R __ ,__t ___. '
FRYOLATOR 1 1r 81 __ _ ti 1
FURNACE _ .. � -• = 'I.: �.._.. �9 � .1W . ....-, [.---1
; ....
GENERATOR �. .- riI -A i, 1 ,; }. IF ei 1 F ir I
GRILLE { 1 Q 1=i
INFRARED HEATER CJIIL1; II =! ' = _. . _,._.�.•• ,
' ' Mir N� _.
LABORATORY COCKS ��• •�'•
MAKEUP AIR UNIT �i � i '
OVEN __- i W( �. ' MI • •- 1 • I
POOL HEATER ` 7 1 1 ,f
ROOM 1 SPACE HEATER _-_
- �i i — -T{____. . j
ROOF TOP UNIT lam 1 1 ( ti t
TEST I I r, I' '' an ...:,in0 f i t
UNIT HEATER h` i €€ i
UNVENTED ROOM HEATER _ mr _ I
WATER HEATER ' _. 4._._- _, ', ' r -11 t
OTHER ' � ... � 1
I '
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 D 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 L'
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 1 LICENSE#t 13417 NATURE
MP U MGF L JP Li- JGF u LPGI Li CORPORATION EP 4008 1 PARTNERSHIP(...,.II#1 1 LLC(_„J#
COMPANY NAME: BOURQUE HEATING&COOLING CO I ADDRESS 1199 PITCHERS WAY !
CITY HYANNIS STATE MA ZIP I02601 1TEL I.508-790-2887 1
FAX 508-771-9696 ' CELL 508-735-9993 EMAIL info@bourqueheatingandcooling.com 1
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ _ PERMIT#
�fC/J1 PLAN REVIEW NOTES