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HomeMy WebLinkAboutBLDG-22-002200 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK wkz,., , f' BLDG-22-002200 ,� CITY YARMOUTH MA DATE October 18,2021 PERMIT# JOBSITE ADDRESS 424A ROUTE 6A OWNER'S NAME SCHAUWECKER ALLEN T G OWNER ADDRESS SCHAUWECKER ELLEEN E E PO BOX 3 YARMOUTH PORT MA 02675-0003 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 GENERATOR 1 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 ❑ OTHER OF 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. 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© MGF 0 JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, l CITY IS YARMOUTH STATE MA ZIP 026641207 TEL I FAX 'CELL 1 EMAIL (inspections anefwinslow.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK K _ ,n' om 3 �`°la=1' CITY YARMOUTH PORT MA DATE 10/052021 J PERMIT# 21_- 27 6 0 JOBSITE ADDRESS 424 A ROUTE 6N MAIN ST. OWNER'S NAME ALLEN SHAUWECKER GOWNER ADDRESS SAME TEL 774-238-6317 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL Li PRINT CLEARLY NEW:U RENOVATION:El REPLACEMENT:ij PLANS SUBMITTED: YES 0 NO APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER OM WINS WMIIII NM NM MI ' BOOSTER 1111111111 Mail Mg 111.11M1111011Waiii MN WM WON CONVERSION BURNER ofig inig iiiii mommg timr rignm-Tmaggi Ili WWII. COOK STOVE _ , . DIRECT VENT HEATER ' 'NMI 1111110111111 111111111111111.11111111011111111111111- DRYER F *----_ FIREPLACE OM OM I NW . . I FRYOLATOR MI FURNACE GENERATOR NM MIER111111.11 0.MI 1111.PIM WO°NM NW 11.1111.1.. ,\ GRILLE 0 _ .l s 14) INFRARED HEATER III GO111.11. LABORATORY COCKSME NM NW MI 111111011111.11111111 111.1111111111111 Ili i ; o MAKEUP AIR UNIT OMR 1 OVEN M `-') POOL HEATER onirimwsauimrmrwomtimmisicaicaffoRw. . . ROOM I SPACE HEATER III.1111111.11 IIII—III-MIN.-1.11111111.1111111015 0111 W Oil ROOF TOP UNIT MITIMIUMMINIMIHICIIMMITITIMINCOMINWINKIMM TEST OW am mum UNIT HEATER1 . .a_. _ f ._. UNVENTED ROOM HEATER OMMW 'M1 MOM WATER HEATER. .....___ ____._..___________ OM 1111111111M MI OK MIMI OTHERit Om ...._. _ . .....___. �`NM I1.1 NM MN ON MI_�NMI PM am poi I • iiiinliiii ! INN 1° W OM 11.11111111 LC) INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ll NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY Li BOND El (75OWNER'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 0 AGENT Ll 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 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 complianncc a rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (..�./71 • // PLUMBER-GASFITTER NAME STEPHEN WINSLOW -1 LICENSE#02298 — SIGNATURE MP El MGF El JP 0 JGF Ej LPG!Ej CORPORATION 2,1# 3281C PARTNERSHIP®#_ LLC 0# COMPANY NAME:_E.F._WINSLOW PLUMBING&HEATING ADDRESS 18 REARDON CIRCLE CITY 0 H YARMOUTH STATE MA ZIP[02664 TEL 508-394-77781 FAX 1-508-394-8256 1 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 141/4rr- Sz�' ti BLDG-22-002200 , e CITY YARMOUTH MA DATE October 18,2021 PERMIT# JOBSITE ADDRESS 424A ROUTE 6A OWNER'S NAME SCHAUWECKER ALLEN T G OWNER ADDRESS SCHAUWECKER ELLEEN E E PO BOX 3 YARMOUTH PORT MA 02675-0003 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ED PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ 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 1 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 ❑ OTHER OF 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. 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© MGF ❑ JP❑ JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: 'STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL (inspectionst7a,efwinslow.com S310N M3IAal N`dld #iIIN213d $ :33d ❑ ❑ ±IV Rd 3H1 SV S3Aa3S NOLLVOIlddV SIHJ oN Sa) S310N NO1133dSN11VNII AlNO 3Sn 210103dSNI X103 3OVd SII-11 S310N NO1103dSN1 SVO HOf108 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK J i=5� CITY YARMOUTH PORT MA DATE 10/052021 PERMIT# 2-z.- 27.6 JOBSITE ADDRESS 424 A ROUTE 6A/MAIN ST. OWNER'S NAME ALLEN SHAUWECKER GOWNER ADDRESS SAME — TEL 774-238-6317 IFAX— J TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL u RESIDENTIAL 0 PRINT CLEARLY __ _ NEW: RENOVATION:® REPLACEMENT:Li PLANS SUBMITTED: YES ID NO[, APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER MR MO.MN NM NMI MI 111.1111.M OM NM PIM NM< . ..,._. BOOSTER :E all OM 111111I Mal 111111r INK 11111111111111. CONVERSION BURNER 1111111111111111111111111111111Mill.I 1111111 11111111111W NW COOK STOVE air OM NIT allt '' DIRECT VENT HEATER 11111111111.1111111MIIIIIIIIIIII amour intiamuwimi 111111111111111111; DRYER 11MO .,. i1.111 , . s— FIREPLACE -01111111-Mil MN IIIIIIOIIIINIIIIIIIMIITOIII KINFRYOLATOR FURNACE itwouffiarrommuniwast ... ---L,...... GENERATOR 1111111 WU 111111.11:;MR MIIIIIIII M k Cv GRILLEW 1 . _ i►,� INFRARED HEATER 1� IM 11.11 LABORATORY COCKS IN 11111,11111 MI Mai 11101.11111MI INK IIIIII lel NIS NM 11.1 MAKEUP AIR UNIT OM ` .OW=MIIMIT 1111111.MOM MK NM 1.1111111011."M OSINMOM POOL HEATER OVEN I k ROOM/SPACE HEATER On am ow ROOF TOP UNIT TEST MS �.. _I UNIT HEATER _ 1 litm UNVENTED ROOM HEATER I.1 ' ,n.:M. ; WATER HEATER �.� I . OTHERfll111111111111111111111$111, 111.11111111 ----,-_ L ' i sioi'M NISI, ', OM -OM IIIIM OM int 11111111111111.1111 alli illill OM NM MN MI Mali LCA INSURANCE COVERAGE �' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY L.1 BOND r 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 0 AGENT 0 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 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 compli"anncc a YPP rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ��.�/71 "` ^• !/ �. -- _ PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP + J MGF 0 JP JGF Ej LPGI LI CORPORATION,+ # 3281C PARTNERSHIP 0# LLC 0# COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING -,-,ADDRESS 8 REARDON CIRCLE - 1 CITY [SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-394-7778 FAX r508-394-825C1 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM I