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HomeMy WebLinkAboutBLDG-19-001227 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK *,* CITY [YARMOUTH MA DATE August 28, 2011 PERMIT# BLDG-19-001227 JOBSITE ADDRESS 1033 GREAT ISLAND RD OWNER'S NAME CHEMICAL BANK TRS G OWNER ADDRESS CIO BANK OF AMERICA NJ8-8450204 845 ALEXANDER RD PRINCETON TEL NJ 08540 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES❑ NO© FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER S COOK STOVE 1 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 1 1 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 0 NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY El BOND 0 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 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 Frank Roderick LICENSE# 1762 SIGNATURE MPD MGC JP❑ JGF❑ LPGI❑ CORPORATIONm# 1762 PARTNERSHIP ❑# LLC❑# COMPANY NAME: Rustys Inc M 7794 ADDRESS 222 MID TECH DRIVE, CITY (YARMOUTH STATE MA ZIP 026732580 TEL FAX CELL EMAIL yt 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 O' -4Y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '6 :TrIP-cr =-aOa 4 Nitil-ffry-s CITY Yarmouth I MA DATE 8/20/18 I PERMIT#& "/cmCv12017 cc JOBSITE ADDRESS 1033 Great Island Road(Guest House) OWNER'S NAME McDonnell GOWNER ADDRESS same TEL 508-771-6601 (FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW:IDI RENOVATION:❑ REPLACEMENT:ID PLANS SUBMITTED: YES ED NOQ APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1, 1, I'_ I _ BOOSTER - I I I'-_-_P __.J_ t w_ I __I 1 BOOSTER I _(hl _I' !' __11.__JI_,..J,_ _ I'_II !I 11_11.____J' I!_J CONVERSION BURNER I Il I` J =N"'—I I' 11___1'_11T..1' 1! 1' t 11_ J COOK STOVE TI 1 1 __J I 1'_r1 I' 1 _ I: I' I' I' I TI DIRECT VENT HEATER I- 11 II—J'_JI__Ji�' I _IL_li ,J 11 I!_11�J DRYER _1,_ 1_' 1,_,_,.,J'_JI I' 1' I' JI___)! t1 h_,J �J, ) FIREPLACE '_.J _ __ I I J __J'___J_J I I _7 _1_I _I' FRYOLATOR II, I' I, j, 11 __1'_._1 h II, 11._.J 1 1 1' I FURNACE I l:--1,--fli I'^l1 I' 11 _J, , 1'�_ __J =l _ _1"..__1 GENERATOR I I' I___P_1'—II__I 1 ,. _I 11 It_ I• 1._ I ( 1 GRILLE I-1'_I'-1!__J1,_1'_I1I'1'_),_Il___II_I'_1'_I'nI INFRARED HEATER 1--1: Ir—P—ll_II..—lr='_ I 117-1115,7_1__11 11-11 I LABORATORY COCKS __,J �1' 1 1'_I I 1, —I -, ;TI _i I I _I _ MAKEUP AIR UNIT I J1_I1 r II_ 1' Il_ _I' I ____J' _ I IIJI _ _l'�II____I OVEN II—1 __.�J'- I' 1' 1' I II— '.r..,�-J1_._I 1, 1 I . _I POOL HEATER '_I ,I I I �1 j� .II 1 I _I mI t ' 1 _I TI ROOM I SPACE HEATER I "—_I'�J'_f' J^__11 _II 1, I I', II_ I I'_I' I,� ' __I ROOF TOP UNIT I— 1, 1'____J 11 ;=I1 _I'-1 —1t_ ,=1'_l'_I ---I _I ._J TEST 1_ I' 1-_-___t_j r _I' 1'___ I .....__-I'___J__I __J I IT—Li —. UNIT HEATER I_I' I. 1' I'__IIII I, I' 11 . III1_I1 1' IT/ UNVENTED ROOM HEATER '--I' ll__1'_J; II 11 P---.11 II I' fiII- I' I1 1 WATER HEATER MINISMANNIMINIXIMIIIIMINOLIINIMMtarnlIMINSIIS OTHERVII'_I1.11111111 _._ 1 INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ej NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY ❑ BOND Q 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 Q AGENT El 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. 7/444 Rae/LS PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE MP[] MGF Q JP Q JGF D LPG/Q CORPORATION Q# 1762-C PARTNERSHIP Q# LLC Q# COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive I CITY West Yarmouth I STATE MA (ZIP 02673 TEL 508-775-1303 I FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com 927836