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HomeMy WebLinkAboutBldg-22-001583 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK II c� CITY YARMOUTH MA DATE September 20,202 PERMIT# BLDG-22-001583 JOBSITE ADDRESS 90 QUARTERMASTER ROW OWNER'S NAME COELHO JOSEPH F G OWNER ADDRESS COELHO KATHLEEN M 90 QUARTERMASTER ROW SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsta7,efwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ El FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK s -mr•Foi®.; 'PAW"k � CITY z YARMOUTH MA DATE 19/14/21 1 PERMIT# 7.--2— i �3 JOBSITE ADDRESS 90 QUARTERMASTER ROW S.YARMOUTH OWNER'S NAME JOSEPH COELHO GOWNER ADDRESS SAME TEL=5082370564 iFAX . 6.... PRINT OR OCCUPANCY TYPE COMMERCIAL[.__,1 J EDUCATIONAL I RESIDENTIAL al PRINT '--- CLEARLY , I NEW: I RENOVATION:i REPLACEMENT:I, PLANS SUBMITTED: YES NO! APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ' S rl BOOSTER _ i CONVERSION BURNER r � ' COOK STOVE F .,. � .:.:.. . .......: DIRECT VENT HEATER ' , '111.110111.11HIMMIMMINNIMIC 1J T-- DRYER 1 ' 11 FIREPLACE .9_ I 1 FRYOLATOR i ,,' 6 , i E FURNACE .M.� � � : �e _ �, .� ..m��.. �marmowitimmultit . m GENERATOR i �' , i GRILLE € ` I LABORATORY COCKS s ' - . .,... . ... MAKEUP AIR UNIT I 1 OVEN 1 1 I ik' t- 1111.1 , POOL HEATER . ..� . ROOM/SPACE HEATER �� I ' 3' °l � _. ROOF TOP UNIT €. .n � ._. TEST r - --1111. ;, '' - .lomll.t6lliimrl", UNIT HEATER UNVENTED ROOM HEATER 4° ' � WATER HEATER = R ... . ...., .... . .. _. .a. OTHER i 1 �.. i Tr _ne.ro I Mr < _ . .., E • I_ �� � � � . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES !l NO '. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ` OTHER TYPE INDEMNITY E�...J. BOND L 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 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 complianc a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • / y -+ .!.r- PLUMBER GASFITTER NAME i STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP Lij MGF I JP!,_,„,1 JGF I LPG! CORPORATION WL. #13281C I PARTNERSHIP? -]#; Lc m ,#' ........ ......d dsaa��en......smew>€ COMPANY NAME E.F.WINSLOW PLUMBING&HEATING I ADDRESS[8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE rMA ZIP,02664 ITEL.508-394-7778 FAX[508 394-8256 'CELL N/A _____.'EMAILI INSPECTIONS@EFWINSLOW.COM