Loading...
HomeMy WebLinkAboutBLDG-21-006804 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t• r CITY (YARMOUTH MA DATE (May 24,2021 'PERMIT# BLDG-21-006804 3i3 JOBSITE ADDRESS 115 WEBSTER RD OWNER'S NAME Ipaula cruz G OWNER ADDRESS MANSFIELD MA 02048-2924 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL III PRINT ❑ NO❑ CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES • FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 ❑ 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 (Ryan White 'LICENSE# 116068 I SIGNATURE MP© MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP 0#1 LLC ❑#1 COMPANY NAME: (RYAN L WHITE I ADDRESS. 119 SKIPPERS DR, CITY (Harwich 1 STATE MA ZIP 1026453122 1 TEL 1 FAX 1 1 CELL 1 1 EMAIL rwhite1011(a)gmail.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 6t 6 -�: PA-1C,EL.` MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FiTTINC WORK w= •_ r.. (St.bG (-00(4°ti �` CITYI �cmo.,tln_-� 1 MA oATI:�__�,_-tom-Li 1H�ERMlr1H JoesrTEnoaREss[ 1 4s lorrNErSNaME I cf-tj t7 ovilERADORESS TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL Li RESIDENTIAL[ PRINT CLEARLY NEwrif RENOVATIO//t® REPLACEMENT:® PLANS smarm TE YES[] NOD APPLIANCES 1 FLOORS-+ 9Sll 1 2 3 4 5 6 7 8 9 10 11 12 13 14 SER ---MK----O-1111111 CONVERSION ��p�BURNER /AWE t --' COOK STOVE _� Y� @• DIRECT VENT i EATER N M M NM M Mt OW OM A all N Mill DRYER I a MB M MN IOW OW- Mr OWBMW .__• ARE E W Mr..•...1 I FRYOIATOR 11111 1111 Ku E Az = gm . --_ (AERATOR MR AM MIK 4=UMW Mt AM MI OM WNW MIN GRILLE RR. simmannummin INFRARED/EATER LABORATORY COCKS 111111amir M)M O 111111111111111 IMF NM M IMF 11111MINIF 1111014111.1 "'ducal)AIR UNIT OVEN III En= MIMIF POOL HEATER IJIM MMPM WNW MI--- 11•1181111111 - ROOM/SPACE HEATER MIS--- WIN 011F.111 __ ROOF TOP UNIT Annan . = = - TEST tMTHEATER IN — M MN= NMI AM--- A 111111111111111 UINENTEO ROOM HEATER WM Off W illi==Wu 111PlilliffiMMMI WATER HEATER -,—MIMOM NW IMF 11111111111111111111101111 OTHER I L M—MS MB NW 011111111•11 HISURANCE COVERAGE I have a await IIS insurance policy or Bs substantial equivalent whits meets the requirements of MGL..Ch.142 YES IF NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF of E BY CHECKING TIE APPROPRIATE BOX BELOW LIABILITY NSURANCE POLICY J OTTER TYPE INDEWATY Li BOND OVIN'EWS 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 OK ONLY: OWNER Li AGENT Ej SKNATUIE OF OMMNER OR AGENT I hereby airily that all of the details and kdar adoe I have submitted or entered regarding this application are by and accurate b the best of ray talon-edge and that al plumbing nock and krsfo0aions parleyed under One permit issued for this application wit be in compliance with all Pertinent yobbo of the Idassacianetts Stale Chortling Cade and Chapter 142 of the General taws. NAME I guA, G.JInr} I LICENSES' SIGNATURE MPC MGF® JP® .IGF❑ LPG!El CORPORATION DS 7—J PARTtEi OP® LLC00 COMPANY NAME{ (, 1t Of:Y_ �ADDRESS .� Z5— ' `` .1 STATE �''ZIP[v4G =JTELf S©Er Z Ifo 737 f i FAX CELL�_� It it �4 r�,•_ /O C �+, r el` C ova