The URL can be used to link to this page

Home My WebLink AboutBldg-22-002428 r �w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - e, c' CITY YARMOUTH MA DATE October 28,2021 PERMIT# BLDG-22-002428 tl JOBSITE ADDRESS 45 SQUIRREL RUN OWNER'S NAME David Lear G OWNER ADDRESS 45 SQUIRREL RUN YARMOUTH PORT MA 02675-1835 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 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 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 0 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑it COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanyagmail.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 ox..) 6 Or MASSACHUSETTS UNIFORM APPLICATION FO- A PERMIT TO PERFORM GAS FITTING WORK t.�e` CITYyc�v,Urou - AAA D TE/5.Z(o .z1 2t- 24z 2 —,. ` PERM€' —�-' �1%YYPC Pc-A."' / JOBSITE ADDRESSp��+ -5 g -OWNER'S NAME 12i yr cP LC i -- GOWNER ADDRESS /. - , TEL J'g/ 'P/ yY�rypx _ TYPEPR OT OCCUPANCY TYPE COMMERCIAL EDUCA isNAL RESIDENTIAL J1/ CLEARLY NEW:VRENOVAT1ON: RFLACEMEN T: PLANS SUBMITTED: YES NO V BOILER .APPLIANCES FLOORS-, ( BEM i 1 l 2 i 3 1 4 1 5 8 } 7 ' 8 9 i tQ 11 l t2 1 23 l 14 I i BOOSTER — _ 1 CONVERSION BURNER - _ _. I s l ( _ COOK STOVE J L -- • DIRECT VENT HEATER I : -_. f __ 1 . - f f - DRYER FIREPLACE l ., FRYOLATOR ( • - _ f I I. I I .. --- FURNACE k I I f f ! f E ' I I GENERATOR 4 I j { , GRILLE I l INFRARED HEATER l i - ! T._ I I - • LABORATORY COCKS - .I ._ . _ I . . --- - - MAKEUP AIR UNIT I ! ,-z OVEN -I -1 -- -- l ( - C . - POOL HEATER I - • - ROOM f SPACE HEATER I - . I - ROOF TOP UNIT I 44`` I 1 . - V - TEST I .r>. I . UNIT HEATER UNVENTED ROOM HEATER I. I f . . l f 1 f WATER HEATER 1 I - f [ I I - - OTHER f 1 I - i f _ i I _ INSURANCE COVIMAGE I have a current Hrat iltty insurance policy or its substantial equivalent which ineeft 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 V 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 ray signature on this permit application wakes this requirement. - CHECK 043E 0 : OWNER AGENT SIGNATURE OF OWNER OR AGENT z I hereby certify that ail of the details and ii io,nrmion I have submitted or entered regarding a are and of my imowied e and that all plurnt n +ng &arid �tI frasone „iw -4 antler ma permit I55U2d for this apptr n will se in pan of the Massachuse#s State Plumbing Code and Chapter 142 or the General Laws. l i PLUMBER GASFITrER NAME ANDREW LEIGIIiON LICENSE# 1E130-M SIGNATURE MP ( MGF JP JGF LPGI CORPORATION / r: 3734C PARTNERSHIP # LLC # COMPANY NAME HALL OIL COMPANY INC. ADDRESS 435 RT 14 CITY SOUTH DENNIS STATE MIA ZIP 02880 TEL 508-398-3831 FAX 508-394-3068 CELL AIL hallolcompanya rrialcorn