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HomeMy WebLinkAboutBLDG-18-6362 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK %DI CITY YARMOUTH MA DATE May 14,2018 PERMIT# BLDG-18-006362 JOBSITE ADDRESS 40 CROSBY ST EXT OWNER'S NAME GREENE MARJORIE J TR(EST OF) G OWNER ADDRESS GREENE DRAGON RLTY TRUST 40 CROSBY ST EXT SOUTH TEL YARMOUTH MA 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL Q PRINT CLEARLY NEW © RENOVATION:D REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NOD FIXTURES FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER • BOOSTER CONVERSION BURNER _ COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 1 GENERATOR 1 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 2 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 © NOD 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 on 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 We 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 Mark Watson LICENSE# 3842 SIGNATURE MP❑ MGF© JPO JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Mark D Watson _ ADDRESS 81 CAPTAIN PERRY RD, CITY LREWSTER STATE MA ZIP 026312559 TEL FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# �¢_f YL{�it_ PLAN REVIEW NOTES i lam/ U)-/C, / O&7 fie LA2// i -,--i•I.:: 1,, • ! 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