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HomeMy WebLinkAboutBLDG-23-005215 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK g {,el r CITY YARMOUTH MA DATE March 22,2023 PERMIT# BLDG-23-005215 I I— JOBSITE ADDRESS 289 OLD MAIN ST OWNERS NAME ADAMS CHARLES E G OWNER ADDRESS ADAMS BARBARA F 289 OLD MAIN ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES ❑ NO El 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 El 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 ILESTER WADE LICENSE# 14569 SIGNATURE MP❑ MGF © JP❑ JGF❑ LPGI ❑ CORPORATION El# PARTNERSHIP El# LLC ❑# COMPANY NAME: ILESTER J WADE ADDRESS. 122 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY ICOTUIT STATE MA ZIP 026352702 TEL FAX ( CELL EMAIL Iinfo(a7ccipaenerators.com • • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • .Z 3 o6.5a/S- ,.. CITY 7 ct�avt C ( y MA DATE 1.0 - `. • JOBSRE ADDRESS .t �✓}Ii { tAtai ii J'`. OWNERS NAME (.,lilt.. k; 4,-rit it "i-S GOWNSImpREsa Si et. L O ve TEL ;U =►tv 0-3 %FAX TYPE OR OCCUPANCY TYPE COMMERCIAL RCIAL❑ EDUCATIONAL❑ RESIDENTIAL Ei C#'ZATP.LY -NEW:! RENOVATION:❑ REPLACEMENT:❑ PLANS smarm: YES 0 NO El APPLIANCES 7 FLOORS-' BS1d 1 2 3 4 5 8 7 8 9 10 ] 11 12 13 14 SOLER BONER CON SANER _ . COOK STOVE • DIRECT VENT lAATERR DRYER • FA FRYOLATOR FURNACE GENERATOR ✓- GRIlE 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 INSURANCE COVERAGE I have a otarentfiebeta Its poor or its substantial equbraket which meals the railroads of MGL Ch.142 YES IS NO ❑ I FYOU MCKEOWN,PI.EA' INDICATE THE TYPE OF COVERAGE BY CHECKING THEAPP ITEBOXBROW LIABILHYINGURANCE POUCY ® OTHER'TYPE RelSONTY ❑ BOND Q OWIEIFS ROMANCE I an aware that the licanias does not have the Insurance coverage required by Chapter 142 of the Nlassediusetts General Laws,and that my signature on this permits tasselsrequirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE CF OWNER OR AGENT I hereby oerRythetaif afthedeb&and WOrmatan I have steed or entered regmere this applcarron am this and emulate b be best of, knowledge and thatae pkmthltg sett and Installagors performed raider the penult issued for this application vft be In compifanoe .,, all :? �� ._�• of the Wassaohusetis Slate Plumbing Code and Chapter142 of the taws. - i t G: 'r PLUMBERS NAME L.'s4-€-r Wade- UCENSES 45bo t'q RE MP❑ MGF® JP❑ JGF❑ LPGt❑ CORPORATION❑R PARTNERSHI'❑S L.Lc[]# MANY HAVE""p e..C i ct Tee teGrs+cer sue{ Pete-ex ADDRESS X3 Bow eta)t'tn Rae 4 CITY Naskpee STATE AM ZP a-Co Lei Tg 50T-411--fTT, FAX 60kAt CELL 60T-150-tee s EMAIL zlrvap c.c.p se¢'►liia-iE-G Es!ab r MAR 2 2 2023 BUILDING DEPARTMENT BY -