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Home My WebLink AboutG-19-1244 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE August 29,2011 PERMIT# BLDG-19-001244 JOBSITE ADDRESS 183 ROUTE 28 OWNER'S NAME THE COVE AT YM ASSOC LTD PTNRS G OWNER ADDRESS %VACATION RESORT INTERNATIONAL PO BOX 399 HYANNIS MA TEL 02601 TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL ❑ PRINT CLEARLY NEW El 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 COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE i FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER 4 - LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 2 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 0 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 1 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 William Heath LICENSE# 12021 SIGNATURE MP© MGC JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: William 0 Heath ADDRESS 45 Main Street, CITY Sandwich STATE MA ZIP 02563 TEL J FAX r CELL EMAIL n" 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 J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PE— O GAS FITTING WORK • iv_Jaw_i CITY Yk'rW d./al MA DATE e a7 tole PERMITS i r JOBSITE ADDRESS IQa3 &NT"C tt OWNER'S flAMECrut sr 1v 1 GOWNER ADDRESS °1/411- 900A- -ts l TEL roe 771 3 L c L FAX TYPE OR OCCUPANCY TYPE COMMERCIAL GY EDUCATIONAL 0 - RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FLOORS-. BSM 1 2 3 A 5 6 7 8 '; ' 9 10 11 12 13 14 O _ M, RNER RECE VED eo --,.. 4 ATER '' -1 ZOtP _�7`*v OUIILOIP-C QCDAPTIhFAS B ..a bGVCrv,I v.\----1 G LLE 1IFC INFRARED HEATER 1{ i E ' V , LABORATORY COCKS i� �. IMAKEUP AIR UNIT 2l1r OVEN . POOL HEATER • 3tllLD Nt�R1MEN ' ROOM 1 SPACE HEATER y: — ROOF TOP UNIT ` TEST .. . . - - - --- . -- -. — UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE ,,..�/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL Ch.142 YES ei N0 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 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. J CHECK ONE ONLY: OWNER 0 AGENT 0 ',. 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 an Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.kti G'Q PLUMBER-GASFITTER NAME LICENSE ft t-z. t.i SIGNATURE MP[r MGF 0 JP❑ JGF 0 LPG!0 CORPORATION❑4 PARTNERSHIP 0# . LLC❑# COMPANY NAME 5f* et..1..J.w Lu„nn.y ADDRESS '/r 0.2-w S%'Km:T CRY t44.4-wvO STATE r''r a ZIP 0 tn. ,? TEL CO 774 Iov s FAX CELL77`/ Y3 2,-,0 EMAKL 4.//sA,)a 330 @ f and ,(,o„, • —• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ;14— to k CITY TMsnwr4l W. DATE 4J d7 E0 16 PERMIT#B6 79-0D 4 JOBSITE ADDRESS 2/? RatonRatonZ-2 NA OWNER'S ME0ut "r'V.M4i 7' OWIJERADDRESS O'41- 900L Qts j TEL 1b6 771 31.LL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EV EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMI I I ED: YES 0 NO 0 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 M RNER TER GRILLE 1 F C TED— INFRARED HEATER 1 " LABORATORY COCKS MAKEUP AIR UNIT 2/ t OVEN a POOL HEATER WILD Nc7i�' = ROOM SPACE HEATER v: ROOF TOP UNIT — TEST a -- — UNIT HEATER r — LII4VEI4TED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE ,,�/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES El N0 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a OTHER TYPE INDEMNITY 0 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 0 AGENT ❑ J 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 tiand that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the 14) Massachusetts State Plumbing Code and Chapter 142 of the General Laws. GrQ PLUMBER-GASFITTER� NAME LICENSE# rya et.'t SIGNATURE MP ElBEMGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑41 PARTNERSHIP❑# LLC❑# COMPANY NAME 34* a..r..Junt ADDRESS '/1 /la''O S•naA-T CITY t44d W�� STATE b4 4" ZIP 0 256 I TEL Cog, 77,( /WM FAX cu1L77Y Ye, 9n0 EMAIL 4.!/454,44- 330 @ y nad 'Con,, • ' ROUGH GAS INSPECTION NOTES ; THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES - Yes No -Ffrit-4-c,J) r �� c� O/5THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /J 0 FEE: $ PERMIT f6 ' 'S �� It ,PLAN REVIEW NOTES _ • •, . • . : . l . , . 1 ?vlyr . . , . , _.___._____-_ ,• . , . ._.._._____--_ , . . . , . ______________-_ , , . �._ ________LL___________- , . _.____L__________--_ i ________________-_ ..