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HomeMy WebLinkAboutBLDG-20-002535 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK TrL A= 01 AI s =V CITY yarmouthport MA DATE 10/16/2019 PERMIT# /,406.'20 '09 AM" JOBSITE ADDRESS 134 water st OWNER'S NAME William Staudenmeyer GOWNER ADDRESS �.......�.............. ... 1 TEL 3671183 FAX.. , TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL El NT CLEARLY NEW: RENOVATION:0 REPLACEMENT:D PLANS SUBMITTED: YES El NOD APPLIANCES Z FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERX ._.....__..,.,.. .. ...._..., ,..,,,_.,.,........ ........ ........,.,.,....,. BOOSTER .............. ..................... ....._.....���_ ...,.�m..._ '.�.._,...,,...,... �,.,.,....�........ f...,..........,......J J . .....,.._..... _....... CONVERSION BURNER ),..,......,_........11,....._.___. _...__.,._.._._L....,,.._........_ L..................... ...................... .............:I,- 11 COOK STOVE I�_._._.,......,..._'L._.�..............: �?..........._._.._ 1J..................,...J......_____.... . L........._........ ...._,_...,.__.. ........,�_,..._..:L...,...............,° DIRECTVENT HEATER �.,,,..,,.,.,..� ..,m_.,...,......I „_m.,..,,,, . f.........._,,,,iJ,.,......,.,,,,..... ._.,,,.........,.... ..,,.......,,..,._,. .,,..._.�. _,.f.F..,....,__,�. .,m._.�.._.�., DRYER1 IL_,m.._JIo.,....,.,w,,,, _,,,d.,,,,,,.,,. t,..,.._._. .,..., FIREPLACE i i 1 l , di a FRYOLATOR FURNACE GENERATOR ��� GRILLE 1W ,I WWI 1 llnt( jl IIIIIIIIIIII Inlli INFRARED HEATER IIIIBIIIIFIIIIIIIIIF,W IWWI IIIIIIFIIIOF !IIIIIIIIIIIIII LABORATORY COCKS IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIIIIIIII MAKEUP AIR UNIT W111111111111111111I I I 11 11111111'�1munrWiinn: OVEN hl1111.hl11111111111111111Finn_unnWWI POOL HEATER 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 ROOM/SPACE HEATER 'I IWI II11111.1111.11.1111111111.111 I11111II I ROOF TOP UNIT 11111111111111111111111111111111111111111111111111111111111111111111111111111111WIIIIIIIIIIIIIIIII TEST --1111111111111111111111111111111111111111I111111111111111111111—UW UNIT HEATER IIIIIIIIIIIIIIII11111111111111111111110111111111111111111111.11111.11111111111111111111111 UNVENTED ROOM HEATER 111111101111111111111111111111111FAIIIIIIIIIIIII111111111111111.111111111111111111111 WATER HEATER _111W10111.111 IW11111111����I �IW OTHER 111. minin- 1,,,. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES n NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Tij OTHER TYPE INDEMNITY El 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: „WNER 0 AGENT D 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 d ac at to est oTmyknowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' nce wy al Pei nt r 'sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J.Famham i LICENSE# 11601 SIGNATURE MP MGF ri JP© JGF LPG'-1 CORPORATION 0# 3698C I PARTNERSHIP®# I LLC©#._. _ COMPANY NAME: South Shore Heating,3,Cooling, ,ADDRESS 57 White's Path CITY South Yarmouth i STATE MA 3 ZIP 02664 -TEL 508-398-6901 FAX 508 760-2681 ; CELL EMAIL info@southshoreheatin9coolin9.com � �P