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HomeMy WebLinkAboutBLDG-22-002879 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `X CITY YARMOUTH MA DATE November 18,2021 PERMIT# BLDG-22-002879 ti JOBSITE ADDRESS 335 ROUTE 28 OWNER'S NAME ZAMBELIS EVANGELIA TR G OWNER ADDRESS Y HOUSE REALTY TRUST 335 ROUTE 28 WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© 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 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 2 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❑ 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 0 MGF 0 JP© JGF 0 LPG! 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbridena omail.com I S31ON MBIA32i Ndld #11012713d $ :333 ❑ ❑ 111AAnd 3H1 SV S3A2I3S NOIlVOIlddV SIHl oN saA S310N NOI103dSNI lb'NI3 AlNO 3Sf O103dSNI 2 03 3OVd SIHI S310N NOI103dSNI SVD HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ',A M-_,,„,__47-1-► CITY MA DATE —�- PERMIT# -0--- Z� JOBSITE ADDRESS`� - (J-7 j- . Z ' (OWNER'S NAME Cpi Pi---------------/ Cti Acta-4G OWNER ADDRESS 5:07j- r fve -- - 5--/ELL 3(p '/- 777 s— -FAX ____, TYPE OR OCCUPANCY TYPE COMMERCIAL' EDUCATIONAL PST _} RESIDENTIAL ; CLEARLY NEW:i___:1 RENOVATION:J REPLACEMENT:°P�- /�esti ce PLANS SUBMITTED: YES r NOkl APPLIANCES Z FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER —J—j-J—1— ,J—J_L__J—1__(_J.—J—Li—1 BOOSTER —J—J• !: 1 I —J'_—_l .—J I- ,__J—_i CONVERSION BURNER I I (____J: I._}__I.____I____I_1 .:_I,_J--j COOK STOVE I_ _-_1 ___±._______I_..—J—J_J:-_ _I-:__-_LI,—• _1. _{_J_1 DIRECT VENT HEATER _i___[J__(,—J___J__I L—j_J .... ..I._J_J J FIREPLACE `- --f - __ ._ J i—J �___1.-1 I- -.L__.1 - _ i I __I i • — — JFRYOLATOR I -��-1._1:—� ._.. _ I—1--f I -____1_2_-_--J-_1—!-J FURNACE —J I—J_.._ I J I I. -J I-_J ._._I I ii? GENERATOR _ .. . 1 ... i . . i 1 GRILLE __.i J..-_1_-__. -1_..._J_a.....--I�_I_�I 1- _._J.—J__--J —_1—J._J INFRARED HEATER -J__-_-_-i.._21:3�l I-- .I_j_J :_-__I I;1-1—J-� _...I LABORATORY COCKS I - _ ' --i I-.._J J I,__J.. !-.-1_ �� I—J—I MAKEUP AIR UNIT1.—.4_J—J k----I ---J. I ___I i—�I J___J OVEN I 1 I_I 1:_____.1,-_-_.-I i __I I'____1,_J____J_.._.J I POOL HEATER _J__J_.J I,.�_I____I I•�-j—_I _..J_._..J .. ..I-�____J-_I ROOM/SPACE HEATER _ _ . ...1��.I :... I I��' I 41. 1-1_ J 1_ ( I I ROOF TOP UNIT .! 1 I-.J 1 1 J ': I____I t—__J______J TEST _j__J I r . h i_______I—I�I 1 i_—I" II UNIT HEATER 1 i . 1 1 1 _j_______I I-_-1.__J ____-I.:____I_-1 UNVENTED ROOM HEATER _J-_J r_I I. _ J 1 __J ;_mo i_J WATER HEATER -- — —- ----_ _a_j I,... ... I i J J .. 1 t�J—_I—) i I__1—_J OTHER ,___ _..,:_..___. . .,I I 1 1 ►_I. 1 1_1 _._ .. . I_ I_� • a ....._ ._ -:. --1 I— __. I_ J I I __J—1'.__1 __J I tI .___ I—___I_ ;—J____-J -- . j I__I—J_,J_______II—I 1_1 i 1- I - . I I I l I i t ..__I __ I_ I _. _ . INSURANCE COVERAGE _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES kr 73 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 4 OTHER TYPE INDEMNITY �.,._[ BOND U 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 4- 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 in compliance rith all P rtinent provision of the Massachusetts State Plumbing Code an Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME,IM ft .ër-, 9:0 ! LICENSE# SIGNA MP MGF J JP JGF:-jj LPG' __I CORPORATION J#` f [PARTNERSHIP:pit'-- LLC _(#; C COMPANY NAEM ' -{)-('6 `i---171- i ADDRESS 3 7- -V '!1.Z-ra/ te CITY '_._. C( r M O tj .... I STATE ZIP 77 TEL -,------ ---7-d----F7-77-_-z3 FAX EMAIL i CELL' - --------_�.. . . . ._ 5� f1 �, ,. L./ r1c , @,e,p,4)t ' rC Ja �. Email: ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El FEE: $ PERMIT# 1'LAN REVIEW NOTES • • V_a 0, 4.-•ir• t' •