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HomeMy WebLinkAboutBLDG-23-005702 `- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '" CITY IYARMOUTH MA DATE April 13,2023 PERMIT# BLDG-23-005702 l JOBSITE ADDRESS 119 PAMET RD OWNER'S NAME ISTADFELD L SETH G OWNER ADDRESS STADFELD ELAINE B 102 STANDISH RD NEEDHAM MA 02494 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS--I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 1 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 El 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 'CARL RIEDELL LICENSE# 18246 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: CARL F.RIEDELL&SON,INC. ADDRESS. 1778 MAIN STREET, CITY IOSTERVILLE STATE MA ZIP 026550000 TEL 5084286365 FAX 1 CELL EMAIL Ierinna,carlriedell.com .- :L MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11, CITY ' . . ; �- -J�! MA DATE_ PERMIT# 6 — S?a Z JOBSITE ADDRESS 1 -_ .a =OWNERS NAME I /G _...:. .... OWNER ADDRESS fi _ I►._ TEL, C) j_Lf2 - FAX' ._.� � TYPE OR OCCUPANCY TYPE COMMERCIAL? EDUCATIONAL ii RESIDENTIAL PRINT y1 ,! CLEARLY NEW.. RENOVATION $ REPLACEMENT ',V= PLANS SUBMITTED: YES L: NOM_ APPLIANCES 7 FLOORS BSM 1 2 3 4 r 5 6 T 7 I 8 9 10 11 12 13 14 BOILERS . . ,_ tl :, l !,1 —ii I -IT BOOSTER �_ 2,...._ ;�. CONVERSION BURNER i )`x =E 11 1 - t1_� IL ' i' COOK STOVE #E DIRECT VENT HEATER 3� _ 11-__ —I— _ -' iE DRYER --lp # i —1.. �, ;_ FIREPLACE i _... . I i,_... .. l FRYOLATOR - -- 1— — FURNACE ...�_. ;'_ 1L � i� — I GENERATOR _ ' V: ' GRILLE 1 ` 1,1 J I . .. ._.' I 'NFRARED HEATER i _ LABORATORY COCKS E I MAKEUP AIR UNIT '- r_._�._ _ _ OVEN , , , i I i POOL HEATER ROOM/SPACE HEATER _.. _. ROOF TOP UNIT f TEST f UNIT HEATER UNVENTED ROOM HEATER T° ._! WATER HEATER,__. .__._.... [ OTHER ` E l E j.,__ ,.....__ ______,H1111H,.11111111i.„____ ___Tir pilinsillillionsollillisinni.111111 -. . , INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i LIABILITY INSURANCE POLICY °. 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 my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT ,_ SIGNATURE OF OWNER OR AGENT 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 compile ith all Pe ' t j Provi^n�.r of he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f i i -._. .: .._-. 1 i I LICENSE# Gp S ATURE PLUMBER-GASFITTER NAME � � ' MP s MGF'.,u__ JP£ ' 'GF' _E LPGI a„ CORPORATION,y # PARTNERSHIP!„,,,, # LLC # COMPANY NAME!' C_ 7' E U.. <L,_.__}...___. ADDRESS n f : ..._ :: CITY c v' i STA E;iN i A :ZIF C r C I ELa - j FAX, I, CELLI EMAIL APR 12 1023 BUILDING DEPARTMENT 6y