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Home My WebLink AboutBLDG-22-00325 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE July 19,2021 PERMIT# BLDG-22-000325 I_f JOBSITE ADDRESS 23 FOREST GATE VILLAGE OWNERS NAME tom edmondson G OWNER ADDRESS 23 FOREST GATE VILLAGE YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 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 ❑ 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 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG! 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsaefwinslow.com 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK !1'MITAslasSz t, li°F( CITY YARMOUTH MA DATE 7/7/21 PERMIT# 6(-O G- Ll—cr-)b 3 -‘ JOBSITE ADDRESS 23 FOREST GATE YARMOUTHPORT OWNERS NAME TOM EDMONDSON OWNER ADDRESS P.O.BOX 2408,BREWSTER MA 02631 TEL 5082370353 FAX., Q TYPE OR OCCUPANCY TYPE COMMERCIAL U EDUCATIONAL Li RESIDENTIAL Ej PRINT 10 CLEARLY NEW.1 1 RENOVATION:EJ REPLACEMENT:IA PLANS SUBMITTED: YES1E NO Li APPLIANCES 1 FLOORS—k BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER Milli[M MallIMIUMMliar mom mot mos ow COOK STOVE _ �E" DIRECT VENT HEATER ' I_ a __ DRYER eirimummirommormoorammormormarmwom FIREPLACE NM 1111.1.1110111 ION NM IIIIIIIIIIIIIIIII 1.1.1.1111100111 MK IIIIIIIIIIII ri FRYOLATOR ,0 FURNACE j GENERATOR €__IIIIIIIIIIIIIIIIII PIM N INN III. 1/3 GRILLE IIIIIIIIIIIIIIIIIIIIIIIIIIIIINIIIIMIIIIF ,,.,. (/) INFRARED HEATER �� MNINIIMIIIIIIIIIIIIIII LABORATORY COCKS 1111111111111.0111.1111111 NV aim air iumuoir Imo limit maw MAKEUP AIR UNIT . ,.. mmiatm-ri OVEN 1 Om Om WORM MBr POOL HEATER ROOM/SPACE HEATER JIM INROWIIIIIJISLMNFIIIIIIINNNRIIIIIIIIMMTSIIIMTIIMIIIIIIIFIIIIII 60 ROOF TOP UNIT t TEST --motaw ow am----mi ammo salorm min ogirmatm UNIT HEATER 01.1.11101.1101.11111.011 IMIONSORKIIIIIIMIMMINIIRIMIN IV UNVENTED ROOM HEATER WATER HEATER _ __ tilitMal. . M alliriliii.110.11111iiitali. OTHER 11.111111131.11111.11.1 MI IIIINWIMINIIIIIM Mt MN NIX 1.111 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES La NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LJ OTHER TYPE INDEMNITY El 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 Li SIGNATURE OF OWNER OR AGENT AGENT Li I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cornplianc aJ1'Ppnine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 71 ` !/ y PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP LE MGF Li JP D JGF El LPG!Li CORPORATION 0# 3281C PARTNERSHIPLJ#L LLC 0#- - J# ..a COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH 1 STATE L A ZIP 02664 _ TEL 508-394-77781 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM