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HomeMy WebLinkAboutBLDG-22-002985 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK --1kcr CITY YARMOUTH MA DATE November 23,2021 PERMIT# BLDG-22-002985 JOBSITE ADDRESS 8 DUFFY RD OWNER'S NAME SMP REALTY INVESTMENTS G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ELI PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS—4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY BOND 0 OWNERS 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 Herbert Healis LICENSE# 20177 SIGNATURE MP 0 MGF 0 JP© JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: (HERBERT M HEALIS ADDRESS. 178 STUDLEY RD, CITY IS YARMOUTH 1 STATE MA ZIP 026642906 TEL 1 FAX CELL EMAIL Ihhealisanvahoo.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES s //, t �._ E I_V ` • •CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` i -,0": gC� Ya m•Uth MA DATE rx11/12/21 )PERMIT# 22- 2.995- _ JOB D ESs[8 Dui/ R:d-- J OWNER'S NAME[ Pacboe 7 Lit !.-ARI MENT B - SS dame ,TEl[ TYPE OR OCCUPANCY TYPE COMMERCIAL[, EDUCATIONAL[J RESIDENTIAL,I PRINT CLEARLY NEW:[] RENOVATION:[] REPLACEMENT:hi] PLANS SUBMITTED: YES[ 1 NO[,,J APPLIANCES 1 FLOORS--. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - — _. ---fr — —17-11-----'-7,1—,_---C,—",—,i'p-A f ; BOOSTER CONVERSION BURNER COOK STOVE s p �I -ir i f¢ .I mss;&�e�` -. ..4-_-L.- ! ,,..��_. I DIRECT VENT HEATER 1. J . W I I III n 11 ti 11 f(j 11 1 DRYER �� FIREPLACE C � .. I �l1�2 1 FRYOLATOR �, ppI ( ) FURNACE -it . Fr 1 GENERATOR 4 (. .� .._ GRILLE INFRARED HEATER f L .I _,:f r _.14._ a — Ir LABORATORY COCKSI, f.. MAKEUP AIR UNIT $ t 1T � i# f(— 11 ri ! 0 OVEN _ .; ..i ezi.0 s...__ _ .:. 1 �2d � s+ POOL HEATER . ,I f fa 14 — I 1 Pe 1�. 1 ROOM/SPACE HEATER g-a-a-",...-5±'—IF 4 F�jr 1 — V.__I. _ f I fU . 7I )"1 - t I itT .I ROOF TOP UNIT ..,-....-1_,. E( 1 � -�' fi _ I TEST _,� ( I it I f1 UNIT HEATER „1,—.—Lir.:.--. 1----__1 ,_ €I ,( , 1 - A A(_ i( I UNVENTED ROOM HEATER [ i1- 11 , F;-,. :Jr::- . li w--ir- L �_--C-::-1/..---ii - I _�I ..---11----If __ �� Ii !� 1 OTHER L.� a .7. 17-7,1E---... r.._� .<:�L.. ,1�. t 1, s.. . t! I _ 1 t. 1 _ f ,I— r- - 1t u ii u r f INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES g.1 NO [II I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY in OTHER TYPE INDEMNITY (_Ti 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 [—J AGENT L 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 714414 /4 PLUMBER-GASFITTER NAME Herb Healls --- LICENSE#[201?91 771 SIGNATURE MP[, MGF[.TI JP[Kl JGF[I LPGI I-1 CORPORATION # Y J PARTNERSHIPL1#[�� j LLC[J#[ COMPANY NAME: 1 ADDRESSI78 Studley rd 1 M_._ i 026 ._.]TEL M08 776 5495 CITY Yarmouth STATE[ �!ZIP[ �� hheaits ahoo tom FAXr j CELLrEMAIL[T GY _,._..y .... . ,..__ . _ -