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HomeMy WebLinkAboutBLDG-22-000869 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ° ' CITY YARMOUTH MA DATE August 16,2021 PERMIT# BLDG-22-000869 JOBSITE ADDRESS 29 SCALLOP RD OWNER'S NAME Michael Sweat G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES FLOORS—F 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 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 Maloney LICENSE# 11247 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPG! 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: MICHAEL R MALONEY ADDRESS. 2508 CRANBERRY HWY, CITY !WAREHAM I STATE MA ZIP 025711003 TEL FAX CELL EMAIL maloneyplumbinq(a)comcast.net 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 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "•^- iii ' CITYL cJt Ye rAl0u 1Lh MA DATE (Fi6 a i PERMIT# 22 — Y(05 JOBSITE ADDRESS iia q -Se a/'6 p Rd Gd OWNER'S NAME Ciltarltf T)e t s&, Cr OWNER ADDRESS TEL V013jc-i 61 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL k PRINT CLEARLY NEW:Nti4 RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOORS—I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 Tin BOILER BOOSTER _ CONVERSION BURNER, COOK STOVE DIRECT VENT HEATER DRYER - r r - FIREPLACE I FRYOLATOR FURNACE 1 _j GENERATOR i _J GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN POOL HEATER r ROOM I SPACE HEATER ROOF TOP UNITC .. i TEST . . . . ._ -— UNIT HEATER (INVENTED ROOM HEATER , WATER HEATER AUG 1 e 2321 OTHER `_ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES X NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 154 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 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 compile wi all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I / PLUMBER-GASFITTER NAME flu,(. Aa CI / o /S Ncc LICENSE# //ati rr SIGNATURE MP' MGF❑ JP❑ JGF❑ LPG(❑ CORPORATION E ti 3 ti 31 PARTNERSHIP❑# LLC❑# AO' ft ADDRESS oO l � e4ler ) w COMPANY IaAMEr�i r at i //j kid )a nit, S 1 � . CITY IIPdrtLIM STATE 1111 A— ZIP a 5'/7/ TEL,Stt�'a2�/Fi' VI/ FAX CELIr5 6 -3i -(nk's3 EMAILint//41` 5 /fib! ea44et / ,(/ V 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 1 ,