HomeMy WebLinkAboutBLDG-17-003193 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
t:v"tf= CITY WEST YARMOUTH - 1 MA DATE:12/13/166 y r PERMIT# 61-0 "/ 7--r-2vl 3 1
JOBSITE ADDRESS 668 MAIN STREET OWNER'S NAME CAPTPARKERS PUB
GOWNER ADDRESS 668 MAIN STREET TEL 508-771-4266 FAX I
TYPEP OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL
RINT
CLEARLY NEW: 1 RENOVATION:El REPLACEMENT:E; PLANS SUBMITTED: YES NOLi
APPLIANCES 7 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1 11,w , ` '
BOOSTER �,_
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER ,,_
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE f,
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT �1
OVEN U L #'()t�
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT 1
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 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 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 to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will b ' `compliance with all Pe nent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME ADAM TRAYNER I LICENSE# 3_880 SIGNATURE
MP MGF
JP® JGF® LPGI❑ CORPORATION.#ff31
e PARTNERSHIP❑# LLC_„, #
COMPANY NAME: ROBIES HEATING&COOLING ADDRESS 279 YARMOUTH RD
CITY HYANNIS ] STATE MA ZIP 02601 TEL 1508-775-3083
FAX 508-534-1272 CELL 774-836-5659 EMAIL MARY@ROBIES.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#
PLAN REVIEW NOTES