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HomeMy WebLinkAboutBLDG-22-000370 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rIL ' C CITY YARMOUTH MA DATE July 20,2021 PERMIT# BLDG 22-000370 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 Q RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 1 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 Cl 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 Thomas Coughlan LICENSE# 8529 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL 111. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GA S FIT TING WORK =�n CITY ^ _ G MA DATE' _- ^_ PERMIT# i,D co -2L-c,,c 3?6-. � JOBSITE ADDRESS' 177{ SOU 79 W l OWNER'S NAME ��I-M_ G OWNER ADDRESS 7�2 " �-- -- ,-� Cam,"� � - _ /�19wi9C�7z.�- -- TYPE OR OCCUPANCY TYPE COMMERCIA PRINT EDUCATIONAL F-- CLEARLY l� _1 RESIDENTIAL NEW:U RENOVATION:_-.I REPLACEMENT:L APPLIANCES 1 FLOORS-. BSM PLANS SUBMITTED: YES NO' BOILER BOOSTER WM--__.-I M "®�._1 10� 10 11 ® 13 KM CONVERSION BURNER ®arn �I �f��:®_ 1®___.1�—}® COOK STOVE ®--'--I_IMBUE t; I --I�--�� —1 ®� i®�® ®�1--J_I_____I-i RYERT VENT HEATER WIF :�._)_ill._J®��® -4 ® r ®1- ®-.i__AM! FRYOLATOR ----I--I WI_I___J__I___-__:1. I®- - - l I GENERATOR _-J WANK___j___!,j I ®NIM _-r AMC INFRARED HEATER I111111M __j_ I® ___J _I PIN INFRARLABORA D HEAT COCKS �'—'J I.. I---. r r M1_r_.r_._._J___ ____i- OVEN �.J____j- __IM—IMF _I.____I®- --I_1_._r _____j_ f POOL HEATER ® _J ��.! I"_,1�-..-r !®��------r._. J_.._.J r ROOM/SPACE HEATER )—I"' 1 - I ---I _ ROOF TOP UNIT -I -- I I_ I iir I MINI_I_1_I__I_� f i I _�....I......_.....1._._.t� I� I r UNVENTED ROOM HEATER —I I ' WATER HEATER ----I I ,1 ; I ` m ;-� I OTHER ' MEM--_-i-�_AIM f __Jim_ jam 1 I. .J�® � ® ----�mo , t INSURANCE GE I have a current liability insurance policy or its substantial equivalent which meets the re uirem I®� i � 1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF q ents of MGL.Ch.142 YES NO COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _ OTHER TYPE INDEMNITY Li 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 7_III AGENT _-_r 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 knowled and that all plumbingwork and installations performed under the permit issued for this application will be in compliance with all Pertinent vision Massachustts Stat Plumbing Code and Chapter 142 of the General Laws. 9e PLUMBER-GASFITTER NAME _ — U/�114'S Dz46, q j LICENSE# ����..,,� MP� MGF _J JP� � JGF T' s�.w�,.� SIGNATURE J LPGI U CORPORATION=V#_..... _. -�,_� -�; -� PARTNERSHIP I#_-1_- -- _ LLC ; COMPANY NAME:' G 1i ADDRESS 30_ _ -- CITY - STATE 421 6 7�{T -- FAX - EL _ � - �CELL, -... ,fir, i r MAIL` r JUL. 20 2021 .41 B UILi /ll � � � E^JT