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HomeMy WebLinkAboutBLDG-15-002614 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -- WIC CITY YARMOUTH MA DATE November 10,2 PERMIT# BLDG-15-002614 71a- JOBSITE ADDRESS 22 LEWIS RD OWNER'S NAME WALKER JAMES M G OWNER ADDRESS WALKER SANDRA L 511 OCEAN ST HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION:0 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 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 ❑ 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 ADAM TRAYNER LICENSE# 3880 SIGNATURE MC MGC JP0 JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ADAM S TRAYNER ADDRESS 4 SHELDON LANE, CITY FORESTDALE STATE MA ZIP 02644 TEL FAX CELL EMAIL • • �� P� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rile . CITY WEST YARMOUTH MA DATE 1117114PERM T#c I r QO L/Si JOBSITE ADDRESS 22 LEWIS ROAD OWNER'S NAME WALKER GOWNER ADDRESS 22 LEWIS ROAD TEL 508-776-0096 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:Ci REPLACEMENT: '❑ PLANS SUBMITTED: YES NO❑+ APPLIANCES 1 FLOORS-. 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 I I---J i BOOSTER I I I- I -- I— 1 CONVERSION BURNER I I I I I I_ I I_ COOK STOVE I I � — _ DIRECT VENT HEATER ' I I-- I I I I I I I DRYER =1--- I I I I I I I i FIREPLACE MIN I I FRYOLATOR ! FURNACEineasiones- I GENERATOR GRILLE iiiiI _ I I INFRARED HEATER I I 1 I LABORATORY COCKS MAKEUP AIR UNIT I I _ I _ • I I_— OVEN I I POOL HEATER ROOM/SPACE HEATER 1 ROOF TOP UNIT I• 1 TEST UNIT HTER NN•tEO:ROOM HEHET _co,ATERw, n I UUIflI!IUI!IR ame n ris. ,r p vRTIAFNr I I ( I I ur _ / __ INSURANCE COVERAGE I have a curren liabi ity insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ 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 ❑ 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 .. pliance with all •e i • t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r PLUMBER-GASFITTER NAME ADAM TRAYNER LICENSE# 3880 SI AT-•E MP❑ MGF 0 JP❑ JGF❑ LPGI❑ CORPORATION Q# 173 PARTNERSHIP❑# LLC❑# COMPANY NAME: ROBIES HEATING&COOLING ADDRESS 279 YARMOUTH RD CITY HYANNIS STATE MA ZIP 02601 TEL 508-775-3083 FAX 508-534-1272 CELL 774-836-5659 EMAIL 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 1