13-073 (29) 12
Commonwealth of Massachusetts
Division of Professional Licensure
Board of State Board of Examiners of Plumbers and Gas Fitters
1000 Washington Street• Boston • Massachusetts • 02118-6100
SPECIAL PERMISSION GAS - ELEVATED PRESSURE
PAGE 1 of 2
$86.00 Non Refundable fee by check payable to "Commonwealth of Massachusetts"
PLEASE PRINT CLEARLY
Engineer Name: Title: Date:
Carl Bernhardt 7/20/2015
Firm Name(if Applicable): Massachusetts PE License Number: Work Phone:
27576 203-272-4620
Street Address: City/Town: State: Zip Code:
424 Cedar Lane Cheshire CT 06410
Cell Phone: Fax: Email:
ALL OF THE FOLLOWING ITEMS MUST BE INITIALED. IF LEFT BLANK,THE FORM WILL BE DEEMED INCOMPLETE
AND WILL NOT BE ACCEPTED.
1.1 have properly filled out and included page 2 of this Special Permission Gas form including my Massachusetts RPE INITIAL BELOW
stamp and signature CB
2.1 have included Two!21 identical plans(stamped and signed)of the complete gas piping system including: INITIAL BELOW
a. Gas piping schematic only(no other services should be included on this plan).
Exception:1 have highlighted all of the gas piping involved in this project.
b. Pipe size shown at all locations
c. Maximum BTU input at the source
d. Maximum BTU input shown for each branch location
e. Equipment schedule showing the Manufacturer,Model Number,BTU input and Board Acceptance Number
for each gas appliance.
f. The equivalent piping length from the meter assembly to the most remote outlet(appliance)
CB
INITIAL BELOW
3.1 have included a complete riser diagram showing the gas piping system with this application
CB
INITIAL BELOW
4.1 have included with this submittal a letter from the serving gas supplier stating the pressure they will be providing
and the total combined gas load through that meter assembly. CB
5.1 certify that the TOTAL COMBINED GAS CFH LOAD entered in box number(3)on page 2 of this application exactly INITIAL BELOW
matches the TOTAL COMBINED GAS CFH LOAD stated in my letter from the serving gas supplier. CB
INITIAL BELOW
6.1 have included a check or money order for$86.00 payable to the Commonwealth of Massachusetts
CB
Signature of Applicant Date:
® TEL: 617-727-9952 FAX: 617-727-6095 TTY/TDD: 617.727.2099 http://www.mass.gov/dpi/boards/pl
SPECIAL PERMISSION GAS - ELEVATED PRESSURE
PAGE 2of2
PLEASE PRIlV T CLEARLY
1)PROJECT LOCATION INFORMATION:
Name of Project(example:Company Name,school,etc) Phone:
Rockridge Retirement Community 413-586-2902
Street Address: City/Town: Zip Code:
25-37 Coles Meadow Road N'ton 101060
2)SERVING GAS SUPPLIER INFORMATION:
Natural Gas Supplier Company Name: Phone:
Columbia Gas of Massachusetts (800) 688-6160
Propane Gas Supplier Company Name: Phone:
3)ADDITIONAL DESIGN INFORMATION:
Total gas load in cfh for "equipment: Total gas load in cfh for existin equipment: Total combined gas load in cfh:
0 5,000 cfh 5,000 cfh
SEAL OF MASSACHUSETTS RPE In requiring special permission for the installation of
certain gas fitting applications, the Board is, seeking to
OF Mqsverify a Massachusetts registered professional engineer,
as indicated by affixing his or her seal and signature to
p CARL °r"y; the application, used due diligence to ensure the gas
H' s stem design and installation will work safe) and
BERNHARDT, JR. y g y
No.67576 p 1° effectively. In addition, that the system installed complies
A'j'�FGISTE���� with Massachusetts General Law chapter 142, 248 CMR,
OFFSsrON V_
_L and all other applicable codes and standards. The Board
relies solely on, the representations of the engineer for
Ccompliance with these requirements and does not
G-- ,- -� warrant any installation or design or otherwise perform an
independent review to verify the engineer's
SIGNATURE AND SEAL REQUIRED representations
4)FOR BOARD USE ONLY:
Special Permission granted: Date: By:
Conditions:
Additional Notes:
Go =U a Gas
of Massachusetts
A NiSource Company
2025 Roosevelt Avenue
Springfield, MA 01102
July 20, 2015
Commonwealth of Massachusetts
Division of Professional Licensure
Board of State Examiners of Plumbers & Gasfitters
1000 Washington St, Suite 710
Boston, MA 02118-6100
Re: Special Request for Elevated Gas Pressure
Dear Mr. Peluso,
This letter is to confirm that 5,000 Scfh of natural gas is available at Rockridge Retirement
Community at 25-37 Coles Meadow Road in Northampton, MA. The natural gas will have a
specific gravity of 0.60 and a heating value of approximately 1 ,000 BTU/scf.
The pressure in the gas service supplying our meter will be approximately 50 prig and the
delivery pressure at the plumber's connection downstream of the Columbia Gas of
Massachusetts' regulator will be 5 psig as indicated on the schematic submitted for this
Special Permission Gas Request Application.
The information contained in the letter is in compliance with the Massachusetts Fuel Gas
Code, and does not constitute a commitment or contract to deliver gas to the above-
mentioned address.
If you have any additional questions, please contact me at the phone number and/or email
address below
Sincerely,
,�O� 44t,�
Bryan Meccariello
Field Engineer
Columbia Gas of Massachusetts
Phone 413.326.0636
Email: bjmeccariello@NiSource.com
METER AND P.R.V. BOILEjc-fh
1 112" 1 112" BOILER
BY LOCAL GAS M 2,500 15' 15' 2,500 cfh
SUPPLIER
P.R.V.
(50 p51g to 5 pslg)
211
120'
I
I
I
i EXISITNG 5 PSIG
rOU5E LINE TO H
I REMOVED
I
EX15TING METER
AMID P.R.V. TO DEI M �
REMOVED u
LONGEST DISTANCE: 135 FT.
REQUIRED PRESSURE: 5 PSIG. (EXISTING)
TOTAL LOAD: 5,000 CFh (NO ADDED LOAD)
NOTES
- All piping sized in accordance with the National Fuel Gas Code.
- All piping shall be tested @ 100 p516j and subject to local
Inspection P.E. STAMP
- All pipng shall be labeled in accordance with applicable codes. ROCKRI DGE RETIREMENT COMMUNITY
- All piping shall be welded to the inlet of the Isolation valve. ��P�t" OF'''°ss,�
- All P.R.V. vents shall terminate outside and berotected from oz CARL
p 25-37 COLE5 MEADOW ROAD NORTHAMPTON, MA55
inclement weather and insect Infestation. o " r
BERNHARDT, JR. PLAN OF PROPOSED ALTERATIONS AND RELOCATION OF EXISTING
- It Is the responslblllty of the piping contractor to obtain all A 1 GIS-reNo.Z7576 o
F 'v ��, ELEVATED PRESSURE SYSTEM TO OPERATE AT 5 PSIG.
required permits and insure that the piping system Is Installed in SS0 AI�G�`�
accordance with the National Fuel Gas Code and acceptable piping SCALE: Not to Scale DATE: 7-19-2015
t
pracices. �!,�-' REV A PAGE: I of 1