HomeMy WebLinkAboutBLDG-15-003528 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY West Yarmouth MA DATE 12/23/2014 PERMIT# /jib--15--003''' /
JOBSITE ADDRESS 41 Skyline Dr OWNER'S NAME George Barton
GOWNER ADDRESS Same TEIJ FAX
1?\ TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL 0 RESIDENTIAL
PRINT
CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOD
APPLIANCES 7 FLOORS- BSM ' 1 2 3 4 5 6 7 8 9 10 11 i 12 13 14
BOILER
i.--BOOSTER .. ^ N
i A
CONVERSION BURNER ` ` _
COOK STOVE I
DIRECT VENT HEATER
DRYER ' r
FIREPLACE '
FRYOLATOR , f
FURNACE ( I 1
GENERATOR 1 I
GRILLE l -_ I
INFRARED HEATERJ I 1
LABORATORY COCKS '1
MAKEUP AIR UNIT l {
OVEN i I I I _
POOL HEATER (I
ROOM I SPACE HEATER I 4
ROOF TOP UNIT I • 4 1
TEST - I
UNIT HEATER
• UNVENTED ROOM HEATER ,i i_I gi. 1 III 1
WA ZWE4TbR I
OTHE A` 1_ _
II�'� 0 ✓� S �. l
DEC 242014 - •
INSURANCE COVERAGE
I have a Alrter<t tia ergibiait alit y or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0
I IF YOU-CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 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
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 ccmpli th all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME JASON DREW LICENSE#J-30 SIGNATURE
MP❑ MGF 0 JP 0 JGF 0 LPG!0 CORPORATION❑#I PARTNERSHIP❑# LLC❑#
COMPANY NAME DREWS PLUMBING ADDRESS 6 AGASSIZ ST
CITY BREWSTER STATE MA ZIP 02631 TEL 508-360-1400
FAX 11.111111.1111 CELL t EMAIL _^, --- __ ________-______ 4____
Acl.APc\ fee
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
'iktte--__ CITY West Yarmouth , , _ MA DATE 12/23/2014 PERMIT#
JOBSITE ADDRESS 41 Skyline Dr OWNER'S NAME`George Barton
GOWNER ADDRESS Same TEL' FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 9
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
APPLIANCES 7 FLOORS-0 1 BSM ' 1 2 3 4 1 5 6 7 8 9 10 11 12 13 14
BOILER I 1
BOOSTER i r f I I
CONVERSION BURNER .I - __ _
COOK STOVEk. _ ._ I I I
DIRECT VENT HEATER 1
DRYER
FIREPLACE I I
FRYOLATOR 1 -
FURNACE j _ r 1
GENERATOR l
GRILLE
INFRARED HEATER 1.
LABORATORY COCKS I ,
MAKEUP AIR UNIT
OVEN r I i t -1
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT i1
TEST I I
UNIT HEATER
U NTEr.+s• EE k ; .
WATER ^ :�..r
OTH R if.
. ' ' / i I
_ i
_ - I
DEC 9 I _ _ _ _ _ -
RUlLDINGAEAtRTMENT
BY --at'
- INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 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 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.
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 all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME JASON DREW LICENSE#P-3O715 SIGNATURE
MP D MGF❑ JP 0 JGF❑ LPG]❑ CORPORATION❑# PARTNERSHIP❑# LLC❑#
COMPANY NAME:DREW S PLUMBING ADDRESS 6 AGASSIZ ST
CITY BREWSTER STATE MA ZIP 02631 TEL 508-360-1400
FAX 1111111111111. CELL
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