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Home My WebLink AboutBLDG-23-003287 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1- e CITY E'ARMOUTH MA DATE December 13,202; PERMIT# BLDG-23-003287 1.74 JOBSITE ADDRESS 166 SEAVIEW AVE UNIT 1 OWNER'S NAME LATOURNEAU CRAIG A G OWNER ADDRESS LATOURNEAU COLLEEN R 545 LAMPBLACK RD GREENFIELD MA 01301 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS . BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER • ROOM!SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF 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 cn this permit application waives this requirement. 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 be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME r checkoway LICENSE# 13417 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑ # PARTNERSHIP ❑# LLC ❑# COMPANY NAME: CHECKOWAY ENTERPRISES ADDRESS. 11 scarp)hill rd, 11 SCARGO HILL RD CITY DENNIS STATE MA ZIP 02638 TEL 5083851911 FAX CELL EMAIL checkenta.comcast.net 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 6 ' CITY :_ S �/��(?,�(�/�►,� .. �t I MA DATE /J' '7_ ._.�-a— I P E RM I T # `Z�3 '- 3 Z S 7 JOBSITE ADDRESS_ I CC SE"Vl(w 4,/ k 1 sS' OWNER'S NAME canje 4.7auarikT- 60 G OWNER ADDRESS S " L le TEL1 FAX Y� n�� CFI ( 1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTII PRINT CLEARLY NEW: [__ RENOVATION: [1 REPLACEMENT: "` PLANS SUBMITTED: YES ` NOD APPLIANCES 1. FLOORS-' BSM 1 2 3 1 4 5 6 7 8 9 10 11 12 13 14 BOILER / it BOOSTER - — I -1 1 I CONVERSION BURNER 7 1( 1( - ii . _ COOK STOVE ---= - - - ._ _ . _ �._ ,_.___-., DIRECT VENT HEATER q Jr TMINN J. DRYER �... -- IIIIIIIIIMM1 1----- 1[ - 1 FIREPLACE - Mt 111111 i F RYOLATO R - . '-1. - .- -, FURNACE t --t-- ' GENERATOR 1,-- ill ,tr. :�. I._ _ _ GRILLE _ - P - fr. = i INFRARED HEATER : 11 ._„�. LABORATORY COCKS �_ _ MAKEUP AIR UNIT � MEr �. OVEN _._,�__ _.-_ __ POOL HEATER M y _. _ ROOM I SPACE HEATER f- ll— _� _ ROOF TOP UNIT �r TEST -1 UNIT HEATER tegm 1 ?, ,.. I1 i,+_ I - _ UNVENTED ROOM HEATER _ ,.. i r _--- WATER HEATER _.1 -II 17 OTHER j J L..._ _iL<. ....� 1' 1 _ = ell sue,- I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Fl NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L- 1 OTHER TYPE INDEMNITY FT BOND I 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: OWNE ' I 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 compliance with al -• ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway I LICENSE #[13417 NATURE MP 0 MGF . JP 0 JGF ' I LPGI 1 i CORPORATION LJ# PARTNERSHIP( I# LC LI# 1 COMPANY NAME: Checkoway Enterprises 1 ADDRESS 11 Scargo Hill Road CITY Dennis STATE MA ZIP 02638 ITEL 508-385-1911 FAX 508-385-6858 1 CELLE 508-735-9993 EMAIL checkent@comcast.net J y'� i