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Home My WebLink AboutBldg-22-002885 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK M ,/ CITY YARMOUTH JOBSITE ADDRESS 52 POWERS LN MA DATE November 18,2021 PERMIT# OWNER'S NAME steve cohen BLDG-22-002885 k G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 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 1 BOOSTER CONVERSION BURNER , COOK STOVE 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 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 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP [3# LLC 0# COMPANY NAME: (MICHAEL R MCBRIDE I ADDRESS. 19 Rustic Drive, CITY 'West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL 'stinger.mcbride angmail.com S310N M3IA32i Ndld #1IW213d $ :333 ❑ ❑ 110183d 3H1 SV S3Aa3S NOLLV011ddV SIHI oN saA S310N NOI103dSNI 1YNId SONO 3Sf1 i:10103dSNI 2104 3OVd SIHI S310N N01103dSNI SVO HJl02i • �' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK •,.14::-- CITY :-V. r M Q 1 MA DATE I PERMIT# '2-2 - Z88' JOBSITE ADDRESS, z !J'LovA,S : 4 i,OWNER'S NAME ,„.e-7242.4,7I G OWNER ADDRESS /- 0 Mi (1/ i n k4SS- J TEL Qk -To 4 FAX TYPE OR OCCUPANCY TYPE 5. COMMERCIAL;J EDUCATIONAL _} RESIDENTIAL , PRINT CLEARLY NEW:,J RENOVATION:13 REPLACEMENT:$[L PLANS SUBMITTED: YES D NOXI APPLIANCES 1 FLOORS-0 - BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1__l.____I____i,_____( i4_J_J_-I_.1_ -I-J BOOSTER :_J. J. 1: 1 t- _I'______I-1_____1„.1_-I-J-1 CONVERSION BURNER _I___f 1__1: I______1:_i.______1.____I:_I_ 1,_I•_ I COOK STOVE -J I-_f'-_I.-J-J -1:-J-1-LI=I-�1 -J DIRECT VENT HEATER _-1-J J__J__J I-J_L1�^, .... (.-__ 1_� .-J DRYER. : _ 1 _J.-J_. ._ I... I-1 ..-I I_J I-I FIREPLACE -I..____J_LI- 1_____I...-i,J._�; (--J-_-__J _.._-ISI_1_1 J• FRYOLATOR i-J-�;-1.1_17 - -1---1--1_1,_ I-.!_ J -.1-:JD FURNACE I-J _.._ .. I_J__1_-_:_i .. _ 1._�-_!• i_--f-_J -__._I-J GENERATOR .. . l ... ( I 1 1 GRILLE __i__1_1_J___! __1_-1:__1=1-_�_J_-!__�_J _J_J INFRARED HEATER _1 1'-1.-1 1_____1,._J._ J !.-J -I_J'- _I_ 1 LABORATORY COCKS 1 - _ 1.____i_.-._I_-J-J I_J( ... .. ..1�.I_,__`_.i _. 11 1 rJ-1 MAKEUP AIR UNIT _ 1_i OVEN I _ # I___.t__I--_1_._J 1 ,J, i'J .__ __.1_I J� I - POOL HEATER J_v -1 ! 1__J - 1 1 -1. J__1___1 ___I _I-_J-J ROOM/SPACE HEATER __ I I_ .1 .. i _ i �_I __1 1 1_ 1 1__ J 1 : .. I ROOF TOP UNIT I I r I _1 i I _J_J ._E_._j_J`.J J 1 TEST -` i I `,. I I 1 I __--I. i i 's�r_ _ I i UNIT HEATER 1 I _.1 I I_-.__i __1-__1_J i-J: I�1 UNVENTED ROOM HEAT gr1'�-� 1_j I i ._-1. I i i 1 i f WATER HEATER . __ G. /. 1 j-�____i,_I=1 _! _J____I i . OTHER ' I I. 1____i . I I _I I l I_ I i I_J ____I I____►___.__I .__1 ' _1__-J'-1 __J_1 1 I I_ I�i-J -- 1 1 ._.-.1_1—1—i 1_I_- 1 1_ _I 1 I i I i 1 1 I _-I -I 1- l... r INSURANCE COVERAGE I. I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES re NO _ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY .J BOND LJ 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 7 I AGENT ;_J 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't(�.09-c I -- LICENSE# :, SIGNATURE Y l MP _1 MGF 3 JP; JGF'-J LPG! CORPORATION I#'Pry)p 1 PARTNERSHIP_I# LLC J# I COMPANY NAMEr-1 ca vADDRESS 77riit< / i/ -i r J� CITY /-.(( G/\ n l_ S I STATE I ZIP; b -2.-.6-0"TEL - ---:---"- ;---------- -- -------.- -----------4 FAX ------ ---...I CELL' I EMAIL n.J . JvlLjl, J ` L=_- C-c--"--.--,-- 1 Email: 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 'IL IOLA • IL. * sae-e-• 40-, •