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HomeMy WebLinkAboutBLDG-22-000579 h MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE August 02,2021 PERMIT# BLDG-22-000579 JOBSITE ADDRESS 104 PLEASANT ST OWNER'S NAME Christina Luke G OWNER ADDRESS SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES ❑ 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 1 , DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR , FURNACE 1 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 1 , 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 ❑ OTHER OF INDEMNITY ID 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. 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 Mark Watson LICENSE# 13842 SIGNATURE MP❑ MGF © JP 0 JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP 12# LLC 12# COMPANY NAME: (MARK D WATSON ADDRESS. 181 CAPTAIN PERRY RD, CITY 'BREWSTER STATE MA ZIP 1026312559 TEL FAX 1 CELL 1 EMAIL 1pieman83ta7.comcast.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# PLAN REVIEW NOTES ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GASFITTING WORK fJ Ci 1 " 'IctRt\ojT\-A MA DATE /2/2J PERMIT# 41-OG-aiat -coo cil JOBSITE ADDRESS I DL-1 V 1 easekYi 1 S OWNERS NAME @ tLS i/1^IA LSV k_er GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PiRI NT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS-F BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1-". BOILER BOOSTER CONVERSION BURNER COOK STOVE ( _ _ DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR I FURNACE liti I V' . GENERATOR GRILLE - — INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER • ROOM I SPACE HEATER > R E • Ely = .--h-i ROOF TOP UNIT _... ._ TEST . . _ ._. . . . . .. . ._ ...._ .._.._ UNIT HEATER ' I i , i INVENTED ROOM HEATER WATER HEATER _ BU LDIN4. DEPARTMENT OTHER I Bim— ------- 1_ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ 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: 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 accu ate to the)- of y knodge `; and that all plumbing work and installations performed under the permit issued for this application will be in complia e (I(all P, 'ni r-v I. of ie ``Lu, Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME LICENSE# 3ENL / SIGNATUR MP❑ MGF 1E/JP JP❑ JGF P LPG'El CORPORATION❑41 PARTNERSHIP El# LLC❑# COMPANY NAME M A S go,T 1 E S{Zt7�. ADDRESS. J C Apo i ^P-e f'�/ (z.0 CITY (3 l�l�S f STATE 1\44�0`°1 ZIP 0 2.6.2.6..gJ � ( M TEL OU lf 6 7 3 S FAX CELL 7`(21 to I tl"1ci\ EMAIL p cowry 830cD iv1c&.s ti , t L$ ,D c0 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT I PLAN REVIEW NOTES