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HomeMy WebLinkAboutBLDG-19-001226 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ^CITY YARMOUTH MA DATE August 28,201fPERMIT# BLDG-19-001226 Vr .r JOBSITE ADDRESS 1033 GREAT ISLAND RD OWNER'S NAME CHEMICAL BANK TRS G OWNER ADDRESS C/O BANK OF AMERICA NJ8-8450204 845 ALEXANDER RD PRINCETON TEL NJ 08540 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL m PRLNT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES❑ NOLO 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 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 © NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY❑ 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 an 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 MP❑ MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION m# 1762 PARTNERSHIP ❑# LLC❑# COMPANY NAME: Rush's Inc M 7794 ADDRESS 222 MID TECH DRIVE, CITY YARMOUTH STATE MA ZIP 026732580 TEL FAX CELL EMAIL T- 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 "�1=_t _ •CITY Yarmouth J MA DATE 8/20/18 PERMIT#734216 —Ob 133 9JOBSITE ADDRESS 1033 Great Island Road(Main House) OWNER'S NAME McDonnell GOWNER ADDRESS same TEL 508-771-6601 (FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:ID PLANS SUBMITTED: YES❑ NO El APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER .I _l!__ .17.1' l' I I I _l1_11_ltl1 I BOOSTER 1_-_-_.JI,___11 Ii 11 I! I! II ,_)I_____I!____JIL,,,,-II_II ,1!, IF I CONVERSION BURNER . . - tel! 1! L!., 1 1! U_I:. •IILL!In]!—.1!_l 1�11!- i COOK STOVE I i l il! I!_ I! I__1 I i1_1, 1' U pi I _J DIRECT VENT HEATER ig, -,JF_ Il U 11 11 I! 1! IjI!. 11 i_th11_11„, . .11 I! 1 DRYER I11 J1 . .. l h. ,.. _11 II IL IIli11 I'�JI I �1! FIREPLACE , I i >. . .- FRYOLATOR 1 11—11-11-11_11_11_- 1 �)d_ J- 1_11_____J1111 _lu I it FURNACE 1_1,1_11_11. . i ,111....111_ J1, J1J__l!-, J1 11 �J1�.1'_I GENERATOR I I'^I _11_11_11_11,—J1— GRILLE 1_11_11- 1 _._ !-1,1li_JI_I1_J!.__...I!�JI_..-_l1-_._J _ ! l1_I INFRARED HEATER !il' ._1111 til _J!i_ 1!r ! 111.11.111_1 LABORATORY COCKS 1 . I' I:_.I! I'�I I I 11' I, I' '_/1_I' I' I MAKEUP AIR UNIT 1_11 111_11_11_1,1_11_11._11_11_11_11_1 11 11 . . _ OVEN 1111 1 POOL HEATER _11_ il' Ii_ 1 111 11'1- 1 il:i- 'il P i'il 1 111'1 I ROOM I SPACE HEATER -- ROOF TOP UNIT '11'11!_J111-- — — - T J'_I'_I!_I'p_I1_li_I '111i1 TEST ,I'—1 l i '1111 11'11 1111 it ,l it UNIT HEATER I' 11 I 111_1 1_11_11_1 1111 1'11111'11 TI _I UNVENTED ROOM HEATER 1_11_11_,11_11_11_11_11_11_1—_ ' 1 11 WATER HEATER II. (, 1 I; I, li ! I, I OTHER I1 11 I1-1!-11 11 11 h 11_1!-.__,J'._Il_I' !I, 11_11TI I 1 IT I1_ IL I i 11_11_11_11 I. I 1 i I. I I I � _ I �I'�'_I'�1i� I 1' l. I, I ..,... I!1Ii _11 hl ... I1.., ,.. I _. ..-Ilii! 1,111 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES (jj NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0+ 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. CHECK ONE ONLY: OWNER ❑ 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 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. 72414 Racterie4 PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE MP Q MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION Q# 1762-C PARTNERSHIP❑# LLC❑# COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive CITY West Yarmouth ( STATE MA ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL EMAIL mburke(dirustysinc.com 927836 //AV" n )10 5"rc