HomeMy WebLinkAboutBLDG-19-003179 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
"[l--, CITY South Yarmouth I MA DATE 11/19/2018 I PERMIT# --1061 f 00 3f7i
JOBSITE ADDRESS`rBIueRock Road I OWNER'S NAME Darren Meyer 1
GOWNER ADDRESS PO Box 981 -East Sandwich,MA 02537 TEL IFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ❑ RESIDENTIAL❑
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER U U i I 1. U i 1 U
BOOSTER 11 IIU II I I U
CONVERSION BURNER U I 11 I I
COOK STOVE U U I 4 I 0
DIRECT VENT HEATER U.
DRYER 1 LI 11. 0 U 4 I
FIREPLACE 0 0 M I 0
FRYOLATOR U U 1 U II ( U
FURNACE 1 ;! il Ii i U 0 U
GENERATORI
GRILLE 1U U 1 U U 1, 4
INFRARED HEATER U U 1 U U 1 U
LABORATORY COCKS 11 1 11
MAKEUP AIR UNIT
'J
I I
OVEN U If 0 I 1 (
POOL HEATER I II t 1 II
ROOM/SPACE HEATER P ( E 1 U 1 U
ROOF TOP UNIT11 1 1 11
TEST I U U O ( U
UNIT HEATER IU (( U 11UNVENTED ROOM HEATER U U I ) U (U 11 II U
WATER HEATER j U I U 1 1 U
OTHER I U (L II �� U U ( 11 U
ll 11 tl 1 1 11
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 ❑ BOND LI
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. / / i s
L g
PLUMBER-GASFITTER NAME Tygue S Reed LICENSE# 15200 I SIGNATURE
MP 1 MGF LI JP❑ JGF❑ LPG'❑ CORPORATION LI# I PARTNERSHIP❑# I LLC 0# 4047C
COMPANY NAME: Coastal Mechanical I ADDRESS 299 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-737-8747
FAX 508-760-5800 I CELL 508-246-9959 EMAIL lisa@coastalphc.com
a o-
-- - - - _ -
�-
0
� �