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HomeMy WebLinkAboutBLdg-22-000506 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` CITY YARMOUTH MA DATE Luly 27,2021 PERMIT# BLDG-22-000506 JOBSITE ADDRESS 114 STANDISH WAY OWNER'S NAME OCEAN RESORTS MARKETING INC G OWNER ADDRESS C/O COLONIAL ACRES RESORT 114 STANDISH WAY WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 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 CI 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 Thomas Coughlan LICENSE# 4057 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION©# 4057 PARTNERSHIP ❑# LLC ❑# COMPANY NAME: A&L HEAT COOL&HOME INPROVEMEN ADDRESS. 151 Arrowhead Dr, CITY Hyannis STATE MA ZIP 02601 TEL FAX CELL EMAIL I 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 1Z` I- ►ASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK = r Cl � -MO _ MA DATE �1,7i-1 PERMIT#,$C ?a Di�l Es 1< JO SITE ADDRESS I)A.K.,- s A.N1h IS W Gt)4 I OWNER'S NAME -rRiS ii3OPI$NA&CRT -1 OVI�JE f,�ADDRESS COTrA ' TEL 5-08 71S 09351F1 4, Uig OC�'111kNCY TYPE COMMERCIAj EDUCATIONAL J RESIDENTIAL'J; T (tea Y NEW:� RENOVATION:'___1 REPLACEMENTS PLANS SUBMITTED: YES J. NO APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _—J 1 •_.J___J___I_J_._I___I___-1 __I—I BOOSTER _J I I I t___1'-J 1—.1.-1 1 __I_______I CONVERSION BURNER . . ... . 1 I__II._1______I__I -I° I:_J I COOK STOVE _____.1 .. I_1_____I_.I_I_-I:_� —�__I I —J DIRECT VENT HEATER ._ 1 _1______1, t i--j,1.._ ._I:-_1 —j DRYER• _J—J—I.—J J. - . .i I_ i.... .._.t I ._. .I _J-J FIREPLACE ,_"J__I-_J—.J _._.. 1_..�._1_ _ _s I -1 _ .. 1 1�-1 -J_ _J FRYOLATOR - �_ I—J _J:� 1 1 1__ I_J.1-1 FURNACE A t 1 tE. _ J_tJ___J' I_ J 1 :___I ,_-._1 -----I---1._..-I—1 1 GENERATOR I.. .. . I .. I _ I 1 -....._.I 1 11--J- I J GRILLE __a I__1 I.._ __I_J I I_..._ I __I______I____I__ J._._I INFRARED HEATER __I___I_-J_1 I_'_ J 1. J _J____I_____I LABORATORY COCKS I 1.____1 ±.____1-_J I I._J___ ____I1_ J.__ _____1__I 1 J J MAKEUP AIR UNIT I _.._II__I_ J____1___J"__J 1 I_1___I___J.. I OVEN I _1 1 1___I _______I_..__1._._.."I ___I 1 l I__._J__.J I 46, POOL HEATER _I__J__._._1"._..J.-___J_I r.._;_._.___.1 I_J__I_I_I_______I______IROOM/SPACE HEATER __I ! _ _ r I .. I - I I __ 1.__._.I_...._...I I ROOF TOP UNIT .„.1 1 I--- , I- I --- 1 1 I 1__.J J_ TEST _ _I i i_ I_ I _I_...i 1_ 1 1__I I UNIT HEATER ___.1 I 1 M._�. I .� _____J 1• 1__1 i_-._J: , I UNVENTED ROOM HEATER ___J 1 I ___,_ I I 1_____1I_j___1 1 J_�__I i WATER HEATER I I OTHER , I 1 I _I,. I I. I 1 I_ I --_.1 I I—I—i I 1 ' I__I-__! I __1 I 1_._1 . I___.1'___I _I__I-J__J to I 1______I_ _ II I _._1_I_I_I 1_ I II _ I 1 1_ _ _ 1 1. 1 I _ Et INSURANCE COVERAGE EI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY N OTHER TYPE INDEMNITY _,j BOND LI 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 `_I AGENT _J 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 ertinent rovip _ sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _434PLUMBER-GASFITTER NAME'`-'oI�• Cur t,&thA I LICENSE# S a9I- M SIGNA RE MP .KI MGF J JP"JGF._j LPGI.1 CORPORATION if'# 4o51 I PARTNERSHIP (# _ - I LLC:J#-- _ —1. COMPANY NAME:' f L ii t'.`im A.6 4.COPC. AS(r"I ADDRESS S r DA'd S,1E 4 CITY GZ/�ST.. .Y2 ANDu l - - __- 1 STATE �1 ZIP �- -7-�. 'TEL L5D-73 dDo -1 FAX j CELL EMAIL f Ay c 13 G/)4 (4,-, CA", I r8 - 77oR-,P/ (-- 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 0- • t