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HomeMy WebLinkAboutBLDG-22-000069 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY (YARMOUTH I MA DATE (July 06,2021 'PERMIT# BLDG-22-000069 JOBSITE ADDRESS 1210 STATION AVE I OWNER'S NAME IDENNIS YARMTH REGIONAL SCHOOL G OWNER ADDRESS (STATION AVENUE SOUTH YARMOUTH MA 02664 (TEL) TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL 0 PRINTPLANS SUBMITTED: YES 0 NO 0 CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER 3 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 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 (Robert Wilkins 'LICENSE# 112892 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPG( 0 CORPORATION 0#I I PARTNERSHIP ❑#1 ILLC 0#I COMPANY NAME: (ROBERT E WILKINS 1 ADDRESS. 165 BRITTON CIR, CITY 1RAYNHAM I STATE IMA 1 ZIP 1027671784 I TEL 1 ( FAX 1 'CELL 1 1 EMAIL 1 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 GAS FITTING WORK .a 311=,, g ;Yarmouth I MA DATE G7/1/2021 f PERMIT# w , , ITE ADDRESS 210 Station Ave I OWNER'S NAME Town of Yarmouth I c� ER ADDRESS [296 Station Ave 1 TELr508-398-7600 IFAX � z� I.3 RESIDENTIAL LY-1 PANCY TYPE COMMERCIAL , � EDUCATIONAL , � ' RU 1 i-46E (__j RENOVATION 1 _1 REPLACEMENT:L°.1 PLANS SUBMITTED: YES Li NO['' I'PCIANCES 1 w`P OORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER L .�_I. _I V_ if_` :.__. 11, 1 1- - _- ,T - -7 BOOSTER E 7 CONVERSION BURNER 3r M �, �I COOK STOVE ---1— _I I_ I. . t -L _ _. 1 I . DIRECT VENT HEATER _.,_ ___. ___ IP _ - , '4 -. 1 tf Ir DRYER t ` _r__t' __ --._ 1 ._ � , ap i „ FIREPLACE 1 T- I T _ __� i 1 J 1 �r FURNACE _ ._,,.. w �j_.. . . ��._:_ i- __.: FURNACE ! _ _ ' _ -1 i� � GENERATOR y �' — GRILLE --_r-.:.__ _ -_ _.._ _�', 1 I 1 INFRARED HEATER 1 --t-------r,- I —I LABORATORY COCKS L __,_..._._ ._. -. _ � • � _.._- _... 11_,..g.... � .._ , _�... MAKEUP AIR UNIT ' ' OVEN 1 ,. ._ ....._ ..._.. t _ -I POOL HEATER 1 _ i ! ROOM/SPACE HEATER ROOF TOP UNIT TEST ' r 1 UNIT HEATER -: - �_ v UNVENTED ROOM HEATER ? - 3 . : I I ' , '' _ 1 i WATER HEATER ,i ' wa _ � _Y OTHER ! i, i. _ 1 t I t .e.. .. 1 .,.. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ['' 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 I 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 compliance with all Pertine rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - - / , PLUMBER-GASFITTER NAME,Robert Wilkins I LICENSE#,12892 1/ SIGNATURE MP' MGF JP, JGF LPGI CORPORATIONi ,'#`2337 ( PARTNERSHIP', '# LLC # i- COMPANY NAME:iWilkinson Companies I ADDRESS 1405 VFW Drive CITY !Rockland I STATE; Ma I ZIP[02370 I TEL 1,781-335-2622 FAX; CELL EMAIL;Bwilkins@9twilkinson.com