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HomeMy WebLinkAboutBLDG-23-003743 1"" �•••. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH MA DATE January 10,2023 PERMIT# BLDG-23-003743 JOBSITE ADDRESS 71 SMITHS POINT RD OWNER'S NAME NOLEN CHRISTIAN G OWNER ADDRESS 157 RUSSELL AVE WATERTOWN MA 02472 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 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 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT • OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT • TEST 2 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 0 OTHER OF INDEMNITY 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 'Brian Springsteen LICENSE# 112593 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: 'BRIAN E SPRINGSTEEN ADDRESS. 13 WILMA WAY, CITY IE HARWICH STATE MA ZIP 026451450 TEL ' FAX I I CELL I EMAIL Iservice(a).capecodoil.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK sic =li CITY y '!y � ! MA DATE t Z.3 — 3 `13 �. ,w t. _d. k PERMIT# JOBSITE ADDRESS [ i 47. u OWNER'S NAME .,..(w% / r', ? . :n G OWNER ADDRESS L 1 . tthn fgCa±n b w TELL g FAX". TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL€ t RESIDENTIAL CLEARLY NEW:M RENOVATION:0 REPLACEMENT u PLANS SUBMITTED: YES NO r APPLIANCES 1 FLOORS—L BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER e CONVERSION BURNER r f` --- COOK STOVE _ A� zt � ,. DIRECT VENT HEATER -- DRYER FIREPLACE - FRYOLATOR , _ ��.. i 3 f f FURNACE GENERATOR �GRILLE INFRARED HEATER i i LABORATORY COCKS t = , mm MAKEUP AIR UNIT -ma's_ ,� '. � .. � ' OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNITse , 0.1.El= TEST 111110211 VI 1.11101101•11$ON ON Nil NMI Oil 1110111101 NM SIR UNIT HEATER SPIIIMalli NS MI OW � 111.1 UNVENTED ROOM HEATER � � � � �; WATER HEATE F r R OTHER _ r 3 -: •'N'p f yy -�2+erwax✓�uxsa.�mxx'.. ;xce+e' ^�a..rwgwa.w=>ua•s..zn *. .m o-ax q -1i L • INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 ni 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 Brian Springsteen f LICENSE#'12593 SIGNATURE MP i "i MGF I JP i } a,,rN JGF! LPG,i vt CORPORATION I s# i PARTNERSHIP! #i LLC` t# COMPANY NAME:Cape Cod Oil&Propane ADDRESS APO Box 993 � ___ ,,__- ----_ _-_- ---_ CITY rProvincetown STATE I MA I ZIP!(02657 ITEL!508-487-0205 CELL!508-726-8081 ! m` � `mm FAX 1508-432-0617 �EMAIL;service�capecodoil.com