HomeMy WebLinkAboutBLDG-17-004470 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
,-, * =• CITY -11 -4 I MA DATE t7Z/�-7/ .1 I PERMIT#J 6 /'—aO / /6
r JOBSITE ADDRESS5 tics (Gl1'jr!I. U vti f cG 1 OWNER'S NAME Le e,tairc:R1)1911,hs--,1y4,5elliatit
GOWNER ADDRESS p TEO7/a-3k- J61"71FAX1 1
TYPE OR OCCUPANCY TYPE COMMERCIAL J EDUCATIONAL D RESIDENTIAL
PRINT
CLEARLY NEW:[J RENOVATION:Q REPLACEMENT: PLANS SUBMITTED: YES[J NOB"
APPLIANCES 7 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER UMW._. . .. IMPM1MI R•IN. '' . __1 Imo_
BOOSTER IMP NIL .. 'I♦ N ! ...._. : 1 _ I
CONVERSION BURNER {RR1 Q, I 11111. ' ;_; IM
COOK STOVE i I i — —- 11
DIRECT VENT HEATER , II i _ I ;
DRYER �,. I-_ I _.
FIREPLACE
FRYOLATOR - � ! I !
FURNACE ,,,
GENERATOR ;I' 11111111111— 11- ''— i'' r `
GRILLE E i.�..___�1' r
INFRARED HEATER ;��� I_ Jl '� _ ilillirtl!rn
LABORATORY COCKS 'I I
MAKEUP AIR UNIT i I R I i �� I' 1
OVEN .. I a _ �� E. :_ 1'
POOL
EATER
ROOMY PA E HEATER i
�_ (I i _
ROOF TOP UNIT 1 +! 3_
TEST a RdI _ _ .. �. ai
UNIT HEATER I i El ;i
UNVENTED ROOM HEATER l ;: j. " i 11
WATER HEATER _f Ii 1. 'M iL_ I _ _£I
OTHER ,NM _ I 111111U'' •.v..,�1._,,,Ji--.T,[!_,____-
- , _ __, _ RI
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO LI
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY j 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 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 complians. with all • ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME,R.PETER CHECKOWAY LICENSE#!13417 NATURE
MP El MGF LJ JP EI JGF® LPGI® CORPORATION 0# 4008 I PARTNERSHIP D, # I LLC,_]#
COMPANY NAME: BOURQUE HEATING&COOLING CO I ADDRESS L 1199 PITCHERS WAY
CITY t HYANNIS STATE MA__ ZIP!02601 ITEL 508-790-2887
FAX 508-771-9696 . CELL 508-735-9993 'EMAIL info@bourqueheatingandcooling.com
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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