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HomeMy WebLinkAboutBLDG-23-004780 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7 CITY YARMOUTH MA DATE February 28,2023 PERMIT# BLDG-23-004780 JOBSITE ADDRESS 40 MELVILLE RD OWNER'S NAME IWALSH JOHN N G OWNER ADDRESS 40 MELVILLE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS--. 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 I SPACE HEATER ROOF TOP UNIT TEST 1 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP© MGF El JP El JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanva(�gmail.com & ), ,------- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _tilt= CITY is,,-„,„ R. i MA DATES PERMIT# 23 _ dn to JOBSfTE ADDRESS_-f( _ e --- I OWNER'S NAME G _. OWNER ADDRESS /r = r( .r t TYPE OR » .r _ �. ... _ ___ TG'�f �- f411FAX l PT OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL CLEARLY Li RESIDENTIAL NEW:Q RENOVATION:Q REPLACEMENT:Le"---- PLANS SUBMITTED: YESEj NO APPLIANCES 1 FLOORS-, ssM t 2 3 BOILER ¢ 5 6 7 8 9 10 11 12 13 14 firt --�; " WIT* ' F4=1 BOOSTER71111WrinitMR I CONVERSION BURNER M _ E1111.1_ �- COOK SDIRECT VENT HEATER wiii.wiintmuggwwwwwwissommi TOVE DRYER Min FIREPLACE FRYOLATO• — --- — _ f a � d 1___1�,,; .. �,� I1 [ GENERAToR WWI .lea INIA .241�ANMMI�1111���1 f_ llt GRILLE LINFRARED HEATER BCOCKSORATORY � { uniomontimMMIANIMMWAIMIt _ E MAKEUP AIR UNIT F POOL HEATER ma `= i( � OVEN t - W i mem awn. ROOM 1 SPACE HEATER ; _ ? ROOF TOP UNIT ��_-' f~=L=���!!'. ' ; t TEST tri m. 1i! UNIT HEATER IMISIVIganitiMMViiniiinillgegr ,., UNVENTED ROOM HEATER -' - at -NOMP— __ _ � I . - L �r 1 WATER HEATER MIRMAIM__ '--- .... __ , .__ _ ____. _.___ __ =_,, , aral.liaa OTHER .i 7. a-< . `INSURANCE "7,COVERAGE i .-..�..__.,.__i.._.,_ ,.__._1 '' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL,Ch.142 YES Q NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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 Q AGENT El I hereby certify that all of the details and Information I have submitted or entered regarding this applicati•- are and - cure : o the•=st of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will.e in corn,lane-with- Pertinr t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. IPLUMBER-GASFiTTER NAME Uiq ,r,o ,, .—�,,� -� LICENSE# � SIGNATURE MP ' MGF Q JP® JGF Q LPG!Q CORPORATION ` _# 3) y c:1 PARTNERSHIP Q#1TM_.` _-_ I LLC 0# COMPANY NAME: X D/C C6 . �),/pe,_ ADDRESSL±:Lj v >3 CITY - - v.... __.___. STATE t--.(A ZIP C '� iC ITEL Sti�c' - 3 [ FAX C•e5:�..���=� CELL ---- - .I... _ EMAIL /cz, > �L. , n x V (/ / G 7��f�ht CGS