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22B-043 (31) Northampton Rescue 4;i } Department Memorandum To: Larry Eldridge, Plumbing and Gas Inspector CC: Captain Andrew Pelis, Peter Jeswald From: Chief Duane Nichols Date: March 27, 2017 Re: Approval of Dual Fuel -292"Nonotuck St. 2qw Given the fact that Columbia Gas is not allowing any new installations or increase in demand of natural gas in the City I am approving the installation of propane in the building at 292 Nonotuck St.The following restrictions will apply to the installation. • All gas piping will be dearly labeled in aocordanee with the gas code. This is for safety,to dearly identify which gas is being transported in the piping. • Signage is needed at the main front entrance and both locations of the natural gas meter and where the propane enterers the building. • Contact the Fire Prevention Officer for wording on the signage and inspection after installed • Permit is secured from the Fire Department for the storage of propane • As the tank location is in the flood plan,tank will need to be strapped down to the cement pad to provide additional stabilization in the case of high water. • Bollards are needed around the tank to provide bump protection. Columbia Gas of Massachusetts A USourw Company 2025 Roosevelt Avenue Springfield,MA 01102 March 15, 2017 Peter Jeswald Re: Request for Dual Fuel Dear Peter, This letter is to confirm that there is an existing gas service to 296 Nonotuck Street in Northampton, MA 01060. The natural gas delivered to this customer has a specific gravity of 0.60 and a heating value of approximately 1,000 BTU/scf. Columbia Gas of Massachusetts understands your need to use propane due to the new gas load moratorium in this market and does not oppose the installation of natural gas and propane within the same building If you have any additional questions, please contact me at the phone number and/or email address below Sincerely, Bryan Meccariello Field Engineer Columbia Gas of Massachusetts Phone 413.326.0636 Email: bjmeccariello@NiSource.com CHARLES Commonwealth of Massachusetts JOHN C.CHAPMAN D.BAKER9 OF GOVERNOR Division of Professions! Licensure ONSUMERAF AIRS AN CONSUMER AFFAIRS AND KARYN E.POLITO BOARD OF STATE EXAMINERS OF PLUMBERS BUSINESS REGULATION LIEUTENANT GOVERNOR CHARLES BORSTEL AND GAS FITTERS DIRECTOR,DIVISION OF JAY ASH 1000 Washington Street - Boston • Massachusetts • 02118 PROFESSIONAL LICENSURE SECRETARY OF HOUSING AND ECONOMIC DEVELOPMENT March 8,2017 Matthew R- Bousquet SB Heritage Way South Deerfield,MA. 0161001373 Unlisted Equipment Re: Variance DAGV 248-Yup Coffee Roasters, Inc.-296 Nonotuck Street-Northampton Dear Mr. Bousquet, The Board of State Examiners of Plumbers and Gas Fitters has granted your request to allow the installation and testing of the unlisted gas equipment at the above referenced location. Work on this project may commence,subject to the approval of the Local Plumbing& Gas Inspector. I have attached a copy of the outline for the field evaluation test which should be followed. The unlisted gas equipment shall be operated for testing purposes only. During this period of operation the parties involved shall be responsible for assuring all safety precautions. Final authorization to allow full operation of the equipment is pending the approval, by this office, of a Third Party test agency report or,Massachusetts Registered Professional Engineer's test report. Sincerely, Charles Kalb Board Counsel Board of State Examiners of Plumbers& Gas Fitters �, TELEPHONE: (617)727-9952 FAX: (617)727-6095 TTYITDD: (617)727-2099 http:llwww.mass.gov/dpl } The Field Evaluation Final Test Report shall include Name and address of where equipment is installed, along with variance number. Name, address, and contact information of third party certified testing agency or Massachusetts registered engineer. Date of testing. Reference the standards and codes to which the equipment is designed. Description of the gas equipment or product (type, manufacturer, BTU input, nameplate,etc.) Sequence of operation Summary of the test results(all gas safeties and related components,venting, etc.) Confirm that air for combustion and ventilation is adequate. Confirm that combustible clearances are correct. Diagrams, sketches and pictures of gas trains and equipment. Other related pertinent information. -__... 3 M. -Cl tw NATUM GAS) f Cliflf t$r -40rimr XISI t 0-f,1.006 A . 1 i�FUY y ..-. w - - W,*N AA �g Af Out-pt nressz,re � i Auto CAD vV f B - SCHEME OF THE GAS REGULAIRM SYSTEM TO FEED THE ROASTER t JOnR 15 KG R04STER __ _ ........_.�15.001.GINP_BPR _ . _ . _._ Uop } a i' ; rt 11110-1�� 1110:4Itz �.� a; :;. i .� � � � � � � � t "�: !- << �! �; � -� _g � .� _. } �<< ;, ` �� ��� ° "� � � � t t �" _ s � '� � $ �„f �'� ,F ,�, :�P r 1 � ,� t; r"t �� .a,. mew,, ..b_.,..w.,�,.,n�,m�, ..�.�,.e�,,�,�. ��.__�.���,. ,_ _��.._.._. CHARLES D. BAKER GAva NpR JOHN C_CHAPMAN UNDERSECRETARY OF Commonwealth of Massachusetts CONSLIMERAFFAIRSAND KARYLle"NANF GN E. PouTO Division of Professional Licensure sus,NessREGaLArroN LIESf;'ECiVEi?1;M 1000 Washington Street • Boston • Massachusetts • 02118 CHARLES eotISMOF STEL JAY ASN 7 CONEMLS510NE R.UIVlSION Of SECRETARY OF HOUSING AND PROFESSk-MAL MEPAURE Et`Owac DEVEL.OPMENF Tangy 9,2018 Matrhew R. Bousquet 5B Heritage`clay South Deerfield, MA. 01373 Unlisted Equipment Re: Variance DAGV 24 8—Yup Coffee Roasters,Inc.—296 Nonotuck Street—Northampton Hear Mr.Bousquet, The Board of State Examiners of Plumbers and Oras Fitters grants your request for a variance from,248CMR 3.04 (1),regarding the submitted field evaluation report dated 12./26/1.7, from Vreeland Design Associates. The Board hereby authorizes Full Operation of a Joper BSR 15 Coffee.Roaster and an afterburner,subject to the Approval of the Local Plumbing& Gas Inspector. The gaating of this request is applicable to this end user and this location only.All other plumbing and gas fitting work if applicable shall comply with 248 CMR.3.00 through 10.00 and all other applicable statutes and Codes. Your attendance at a Beard greeting is not required. ThisVariance 6,in effect upon receipt. Sincerely, Charles Kilb Board Counsel Board of State hxaminers of Plumbers&Gds Fitters !� } TELEPHONE: (617)727-3074 FAX: (617)727-2197 TTYrrDD: (617)727,2099 http,/Iwww.mass.gov/dpl i yes t 1 1 S Gas Pipe entering building 3/A" Gas Pipe along exterior wall to Roaster v" 3/4" Gas Pipe and connection to Roaster Roaster control panel . re AF7€RBURNER r COWROL PANE' 31v.° 29 ift*RG)•4GaT www�rr _ .:a�w•:,.w�r w w•�� .wa1�� 5 Afterburner control panel w ..r l ANE _ ,r- .. •� `,_ .,qq X15 �� _- �w+ ,3 M1�V• aM 9� P .. •,�� 4.�.' r .K . fir_�Jy, —. . ,p* w ELECTRICAL AND GAS SET-UP 8. Open the gas inlet valve of the roaster. 4 t _ Inlet gas valve of the roaster. Finally, atter following all these steps. you are ready to turn on the main switch of the roaster and start working with the JOPER coffee roaster BSR 1. jAN Main switch of the 0. t, ELECTRICAL AND GAS SET-UP 6. Place the extremity of the gas pipe line i ito the roaster gas valve and fasten it with a proper key tool. 1 y .q Key tool 7. Open the respective gas valve of the loyal gas installation F { Outlet gas valve of the local installation. 037.00AOVER R:-N.:0 Dar AGO/2D14 Page 516 ELECTRICAL AND GRAS SET-UP 5. Afterwards, make the connection of the gas pipe line to link the machine to the local gas installation supply. Check if the local gas installation has the necessary rnanorneters, safety valves and regulators. The necessary inlet pressure to property feed the machine is about 20mbar. a q nv + � \99 r SAMPLE OF A LOCAL GAS INSTALLATION The gas pipe that links the machine to the local gas installation can be a rigid or fiexible pipe. Roaster gas inlet valve Q}i.ON`.fJ�R xd:4 i.'�:At,�2P;9 Page Rlfi AND GAS SET-UP ELECTRICAL 3, Check if the local power voltage is the sE,me as the features plate of the machine information. Alb- Name ., plate v els 4. Match the electric plug S. Open the roaster door and check if the drum is rotating according to the connection to the local power connector indicating arrow. 1 x ,I D37.DD170PEh` R-v.;0 DKI h<'J;2014 ELECTRICAL AND GAS SET-UP COFFEE ROASTER HSR 15 t?y s 1_ After receiving the new equipment COFFEE ROASTER BSR 15, place it on its final location. It is advisable to put it on a firm and level base. 2. Place the coffee roaster close to the local electrical and gas feeding spots. `s Electric plug Gas inlet of the roaster connection :., i� ;r F 437.AOJHIPER Rev. 6 bm:AGO/2014 Page 216 H; 19 62 OPE COFFEE ROASTER BSR 15 (Electrical and gas set-up) FET :- ! .. ....... `w) , !• _ _ � N � 7 � •,h _.ter.I �'.,_ 'til �'—�— ,•.w • :+ T� �� ��t '••"rv_. / x yam• w' > K sr a,...,��•:,_. fit I � : .��. -,� s \ � \`/ —,L�'�_, r.^._'.�,-�.`�*�•— nY .. \ •• a.wE:a."a.dee AI t 2"pas pipe it)ABerburn»rAll sank ., ` -.... `b---------_. y ;..,..._. _ : - - - t. K. a"r pae Poe i4 Ro—er/ i i i J T --"--^'. .".._..• CQ#Cf6E OF TW.GAS PxxAA.AT ON M7Eri TO FEED 1)49 ROM-r•'ri SUPJiER �.. ...;_.._.-� JOPER t6 KG P4MTErt 15.001-GiNP SPR �yf )• � _� .._.ter Please contact me if you have any questions or need additional information. Sincerely, „jt�OF!A r1' DAVID A. �G 1 / (? � VREELAND CIVIL David Vreeland,PE No_ " Vreeland Design Associates 3 The roaster exhaust venting is by a 341 cfm fan shat is ducted to a vertical 6" diameter steel flue pipe secured to a section of 6"Metalbestos stain'ess steel insulated flue pipe through the roof assembly_ Another length of 6" diameter exhaust flue pipe is attached to the Metalbestos pipe and to the afterburner. The afterburner is vented to tle atmosphere. Sequence of testing and standard operation: I. Checked gas piping from the 320 gallon propane tank to the Roaster and Afterburner. 2. Turned on electric power to roaster; turned on roaster drum motor and roaster drum fan— this sequence is required to allow the gas igniter to operate. 3. Turned on the main gas valve, adjust secondary pressure regulator at roaster to 8"water column, fumed on igniter switch and lite gas pilot. 4. Turned on main gas burner, adjust flame as necessary and heated the roaster drum to 400 F°. During normal operations the green coffee beans would be added to the drum at this point. The burner and roaster exhaust far are adjusted so the roaster drum does not exceed 400 F°. 5. Turned on afterburner at the burner contr of panel —the afterburner goes through a one minute purge cycle and then the forced draft burner ignites. The control panel has a digital readout of the afterburner temperature. T he 350 F°±exhaust air from the roaster drum fan is ducted to the afterburner where the smoke, bean particulates,and odors from the roasting process is incinerated. The afterburner aistornatically shuts off at 1250 F°which occurs within a minute or two after the standard 15-20 minute roasting/cooling cycle has been completed. The afterburner can be shuto':f manually at any time if necessary. Summary of testing: The roaster and afterburner fired properly and in accordance with the manufacturer's instructions. The afterburner shLtdo,,n at the 1250 F° set point.No gas odors or leaks were detected, Combustion air supply: The roaster fan forced e,�haast is listed at 341 cfm. The 248 CMR 7.02: General Provisions- (2)(a)2b: air openings— 12 cfm per 1000 Btu input. Based on the name plate listed Btu hr. rating of 40,945, the air supply ne-:ded is 491 cfm. The interior dimensions of the older brick building that the roaster is installed is: 30'-9" x 43'-9"= 1.345 ft'-with a ceiling height of approximately 13'-6" = 18,158 W. From an 11.S. Dept. of Energy report titled"Infiltration Modeling Guidelines for Commercial Building Energy Analysis", dated September 2009,the typical infiltration rate was found to be 1.8 cfm per square foot of floor area. Based on this assumed infiltration rate with the existing floor .irea of 1,345 ft' x 1.8 cftn/sq=2421 cfm which is adequate for the required air supply of 491 cfm. Combustion clearances: The rear of the roaster s 36)"from the exterior brick wall and there is the required 2"of clearance between the Metalbestos insulated 6" flue pipe and the edge of the hole through the wood roof assembly. See attached items: A: Diagram of the gas regulation system to feed they Roaster and Afterburner burners. B: Exploded view of the Joper 15 KG Roaster C: Joper Coffee Roaster BSR 15 Electrical and gas set-up D: Photos of installed gas piping 2 �i I II1I�IA Vreeland Design Associates An integrative aQproach to design e gineering and site planning Date: December 26, 2017 To: Charles Kilb, Board Counsel Commonwealth of Massachusetts Division of Professional Licensure Board of State Examiners of PI umbers & Gas Fitters 1000 Washington Street, Boston, MA 02118 From: David Vreeland,P.E. Vreeland Design Associates Re: Variance DAGV 248-Yup Coffee Roasters, Inc. --236 Nonotuck 5t,Northampton, MA: Field Evaluation Final Test Report. Dear Mr. Kilb, The following are the results of my field evaluation, and testing of the Joper BSR 15 Coffee Roaster and the lnproheat Smoke Dog Stainless SD-Refurbished Afterburner,conducted 1217117: Field Evaluation Final Test Report Location of installed equipment: Yup C.otfee Roasters, Inc., 296 Nonotuck St., Northampton, MA. Field Evaluation and testing conducted by: David Vreeland, PE, 116 River Rd, Leydem MA, License No. 46317, Ph: 413-624-0126 Date of evaluation and testing: 12/7/2017 Codes— Standards: M.A State 248 CMR 7:00 Description of equipment: j o i F*PR C)P4 S.Ax"r 6.p.4A..R.N., ...w:"'' r" ,•.a: SOLUTIONS IN COMBUSTION VANCOWER_0 C.,.CANADA - T�,�. tsoaa xsa-aria FAX teb+eas+srr DESIGN ALTITUDE �cIWO FT SYSTEM AFTEPAU"ER WPPj>0 EAT"OjeG:NO. CMOs WS£ REf,NO, YUP COFFEE TYPE OF FUEL PF,0PAt4E tAWxWjs0 Hlrwr IPijT' 7f8.DOB b'RUFe[t Y E111 PCINER 120 flAW-4A Y/6eiV Joper Coffee Roaster BSR-15,40.945 Btu/hr. tnproheat Smoke Dog Stainless SD-Refurbished Afterburner, 760,0€30 Btu/hr. 116 River Road, Leyden, MA 01337 Phone: (413) 624-0126 Email: dvreeland@verizon.net Fax: (413) 624-3282 ,�� ��- } y +,y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA- DATE JOB�,ITE ADDZ.SS,, qb 'VN E R SS NAKI E'yj.-tr� tf""k td] &t cA ADDRESS TEL FAX LL TYPE OR PRIIN"f OCCUPANCY TYPE COMMERCIAL EDUCATIONAL r RESIDENTIAL CLEARI.Y NEW / RENOVATION: REPLACEMENT, PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE 6H (J GENERATOR GRILLE tM I INFRARED HEATER LABORATORY COCKS l­­MAKEUP AIR UNIT j OVEN POOL HEATER ROOM i SPACE HEATER ROOF TOP UNIT I TEST IT HEATER I PLUM ING GAS?rjS PECTOR F"UNVENTED ROOM Wgfff WATER HEATR �rr-r'IWV U r—OTHER 60-1, ff Avojoi- 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 13OX 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, "HECK ONE 0W.": QWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that—a-11-of the details and information I have submitted or entw3o this appliCM-0-1 are I.T013;.i;-.d a.,.;::,jrP-Le to tt,e best of iny aoiwiodc! and that all plumbing work and installations pet-Fnrrnwl under the permit issoe, fcr -Wh1-:':t:...)n".1 he ir. -A-itt,as Pertinent pmn-'pon of i 1-io NlassachLISOtts State Plumbing Code and Chapter 142,.f the Ger,.F.-ra! -7 2 S E;k I'n C.- C ct�ATI!QC ALFREDIi.GEORGE rylip MGP JP AGF LPGI CORPORITN'.-N COMPANY NAMIE: GEORGE PROPANE,iNC. Z' 'D R E SS 3 BERKSHIRE TRAIL VES7. FrY CITY GOSHEN STATE MA ZtF, -1'032-01;;2* —1-266-!�-:6r FAX 413-268-0206 CE_! 3 \ N WE rt t �3t a�3 Aga 196 NONOTUCK ST SP-2017-1010 ties# C0fN1MONNN1 -_ 1_JH OF MASSAC"USETTS .,,B-043 CITE' OF NORTHAMPTON Lrat: til. PERSONS CONTRAC`T INC.; %k I 'll t.%k t,;'. i rel D C{:ATRAC[ORS Permit: Building DO NOT HAVE Ai10ESS TO THE GUARANTY FUND (MGL c.142A') JS-2017-0015t , f 5 )tee_ PERMISSION-IS IIERERV +GRAA I-FI) fO: Con"t k, Ccit2trat=tor: License: ease t;se Bina, DAVID VREELAND 40317 E.iat tii�c t.l: 130680.O0 f,< vlwr.' Nin*:-) '00 t 10�° '�€'d ,, t RAi . fic��ant � . DAV D VREE N D - A T.- 296 € ONCTUCK ST App1kqn1jddre&s: Phone: Insurance. EYDENt A01337 1SSCE 0.1V.i_?1221'1(df 7(1.(j((:(j0 TO PFRF0RT1 THE FOL.I:014"TV WORK:CCNSTRUCT INTERIOR PART O, . t VOODEd1,.I PLATFORM, INSULATION AND CEILING FINISH �j 0AOr U #a OSI THIS CARD SO IT Is VISIBLE E°RONI I HE S TREE� ,{ Inspecior of fliumbiug Insperfor of NAiring D,P,W. Building Insp(vtor F:n€lergresnaiti �.­ ,? sert€ct: Meter: Rau h: Rough: t rl :use 0 foundation: Dr,ikek-.sy Final: i Final: f x Final: Row!h Fr'a+ne: _[ 471.7y� Gay�r►� j �'� �� Cas: Fire Department ireplaee>' hinis�e�: - "' Rau2rr: 71: InsulatOn: -01,W , Final: Sfnoke: Final. C"' THIS PE UMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VI LATION OF ANY OF ITS RULES AND REGULATION'S. Certificate of Cccu anc Z!QL,`15/7' Si nature: ev]s pe: Date Paid: Amount 17():i;tt t1?} l )ft fast 212 Main Street. Phone(41 )587-1240. Fax:(4 13)587-12272 Louis ilasbruuck- l3wildinaComr:issioner f � # `"' $ � , ���� � PREP KITCHEN AND STORAGE d � 111r d :a'-t 3/4"a• :21'-r ' m q a jyg8pp REST RM- W N O WINE STORAGE Y y ±21'2"x±10'0" ° Q align REST RM- o y IV t,a��� New door&frame- o U) N HALL 36"x80" ne - c.keggea�or c. 82 ro"""tor back bar N Oc L_ O 11•step. °"°^"' - - - 0 m STORAGE a p�p Cased window o -0L JA1� dram ann opening to bar. O Q O o Modify selves as htww - 3biY°"* •"a-`- I VESTIBULE (L V nZ \J required for new °l"x '�•••• waato ❑hos[stand 30'x80'cased °� °� °� oppr,:ft swMq of -- 4- -4 dovlomexbrww Project ID: 19-009 opening entry to -- ------ aoor al ueurq back bar area. "°„e°d01 ""�' enny+ Install new window in Drawn by. JPB 7 I location of exsting, 1T-7 3/a'BAR removed vestibule Checked by: JPB 4'-6" door. rrow ww wmi maecn aaMc.m .warp ivw wr Scale: AS NOTED —._—.— —.—.—.—.---.-- ——— ————— —— —. .—.—.— Date: 3/31119 Install new window in i location of existing cased openingKITCHEN. i 12-16 aaata at table aullnq(16 sbdm) PROPOSED a DINING ROOM I FLOOR PLAN T528—W a1MMb aa-IV O PLAN NORTH I 49 seats A-1 1 o s oFT PROPOSED FLOOR PLAN I i PREP KITCHEN AND STORAGE REST RM, LU to D 0 Post this location(TBD in demo) (Y' 0 REST RM. Lu 0 0 C t= U) , F),-- E2 --- ------------ z c' 1 V stop 2 E STORAGE shelves bench U) :9 U '0 HALL VESTIBULE 2 0 a. z Project ID: 19-009 Dram by: JPB 3'-W 5 12'-2" I 319'-10• Checked by: JPB Scale: AS NOTED —-—-—-—-—-—- -——-—-—- -—-—-- Date: 3/31/19 KITCHEN EXISTING M 2 C F==l FLOOR PLAN DINING )M I TO PLAN NORTH EXISTING FLOOR PLAN 1 1) 5 10 FT EX-1 Scale:3/16"=1'-0" — r WIASSAC LlS2TTS +JNIIOp u9 AFPL'CA T 1f0N FOR A. FPERFORM PLUMBING WORK ., 7-✓` d�7t�.�"` ,i'". 'ta ri• a"R �''. L)A cs 'm,,. ;,ix 1Z -CRE .S JLuE TE --CRESS c;r�� ��� r tlt d_ `v €'SC # A-)CRESS '�7 `+�'"'r'�"' s .. E.n'�'.,'Q•. s'. I r�P,^ st ,EL. _ J'�'_._'' ` '' ' ;''....,_._ j _ TYPE OR CLEARLY _ c> _J3 CROSS CONNE 710 - - — --- - - -� i t °'S .N HEF € l �..r. <. _ u!0 D:S?0SEo,EA DRAIN 47plor-1 _ �K H-- i l g l INSURANCE COVERAGE: I have a currant Gab l v irs::rance policy or its substantial equivalent which,meets the regv raments of'r`C_Cr'-, -4. yes No M s � t IF YOU CHECKED YES,PLEASE INDICATE T'FE TYPE OF COVERAGE BY C9ECK,1NG-THE APFROP?IATE 50X BELOW L'—ABILITY INSURANCE POLICY � OTHER TYPE OF tNf E'a*W'1`Y ?1 EOND (7 OWNER'S INSURANCE WAIVER.i am aware that the 11censes does rct have the ii;suranca coverage required by Chapter 142 of the Massach';:setts General Laws,and that my signature can this permit applicato nziyes this requirement. CHECK ONE BOX CN'-Y: OWNER =i AGENT !� S3en t"ire fl=Cw r vn .�CBni FIereby certify that ati of the details acid irforrratjon 1 have submitted for enterers} -agarding this application are true erd accurate to the est of ny Knowledge and that all plumbing work and inetaliations performed under &e permit issued for this appiicstion will be in compliance with.allFert�nent provision ofthe N',assachusetts State Plumbing Gose and Chaster 142 of the General Laws. =`�119d=r NAME y r CCr,ponATio%� 7#- # f - Foe t E µ x a A o -4 alr-11 m 4 ASSSACHUSETTS UNIF0RM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0i TY - Jti"E.ADDRESS ° OWNER ODRESE VPF O . `�, vCltUMERCIAL '., "I..'U,+AT14..+Nl„ REPtA+CEENT APPLIANCES-1 F OCR,--- 3 OILER BOOSTER ^00K STO"VE W m . g ji ry i - DRYER i ® 1"iFEPCEw _. r- 1";:RYOLATO i -URNACE 1E ERA �O 3R i-LE ORY CC 'HEATER ROOLUSPACE HEATER ROOF TOP,UNIT , TEST -- ® _. LN1T h?EATE�? ,. .__ t;h(VEtvTEmD Ria EATR WATER HEATER CTE INSURANCE CCVERACE I have a currert a a ili insurancepolicy or its substantial equivalent which meets the-cquirements of WSL C"°142 ES , N0, f l IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKI14THE APPROPRIATE BOX BELOW LABILITY INSJRANCE POLICY OTHER TYPE IN E tNITY BONO , OWNER'S INSURANCE RANCE WAIVER:I am aware that the licensee does not have the insurarsce coverage required by Chapter 14,E of klas achusetts General,Laws,and that soy signature ort this permit application wives this requirement. CHECK ONE ONLY: OWNER aENT 's:°4 Y t9'}+ 'ch�cat all of tt:e CIetai;s and �'t'i"iC >,",Pef&�a!^o,�"iss ,`.E4$t��C€c`z'!'re Xr;�e and r'�{c33e;rr"3•t =rad tha'all pIure Nng vvork and instaflat€pans pec the t-*reit.,_.lp-fx!Ns ai pl`s,af<ot.-.aril!be w mrifianze wl;tt of Massachusetts State PlIumbing Code and Crg„{, ."2 t'00 T-„ ; «t j a. ° ,..,�,,,,. vmui �” ,..�..v.«-�iyvran�.uay.�ao-ra ......cirs,.�ar�zn ....✓et;..o x,.„,,,.,,,.,,<z«.«T..«�.,.��.........-..r�.fG.G.ca" wa.�:2.ww.»:.,,.. <„a....,r«.,...,.��2/., r c. -...%;??�'�;: ROUGII GAS INSPECTION NOTES 'rill$PAGE FOR INSPE 'FOR USE ONLY 11NAL INSPEC FION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT U D PEE: $� _ PERMIT#_-- �AN RFJEW NOTES f