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HomeMy WebLinkAboutBLDG-23-004756 `� . . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ILCITY (YARMOUTH MA DATE (February 28,2023 PERMIT# BLDG-23 004756 5 JOBSITE ADDRESS 19 EIDER ST OWNER'S NAME (COVELL RICHARD B G OWNER ADDRESS 9 EIDER ST YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Ell PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 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 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 ❑ JP❑ JGF❑ LPG( ❑ CORPORATION❑#I ( PARTNERSHIP ❑# LLC ❑# COMPANY NAME: (ANDREW R LEIGHTON ( ADDRESS. (20 Brewster Rd, CITY (W Yarmouth (STATE (MA (ZIP (026735706 (TEL ( FAX I (CELL I 1 EMAIL Ihalloilcompanyna gmail.com ( MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ="i3= CITY . G3 cm_ _______. . _ . j MA DATE WNW-. - PERMIT# JOBStTE ADDRESS__a_ c "-._...r__ _..- I OWNER'S NAME ,‹ C,?_. ye fl . GOWNER ADDRESS << TEL 1 FAX I____—_-_-.,. I TYPE OR OCCUPANCY TYPE -. COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL CLEARLY NEW:El RENOVATION:Q REPLACEMENT: ' PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-' 8SM 11 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ,,. k.:.- _ % _�16_ 1� I` BOOSTER _. - _ w. __ CONVERSION BURNER --- t =-3 - '� COOK STOVE _� ._� — r�' i _ I�. i DIRECT VENT HEATER `ib ro Y- ri s��_.. I V DRYER _ .-�" . ^I i'__ _ . -. . . R,( — .�. FIREPLACE _�.a. - j ,'-- ____ FRYOLATOR �I �.- � �.N..T.__� � ;� FRYOLAT -I,_� _. " I i_ _.1,=-i ii i I �1 FURNACE ...i. . I,�- `r I'_- -_ �'({= € .._.._ �` _ GENERI I GRILLE Ii _.� -_w-- .`. - ._ I_� _ MI-_I INFRARED HEATER `E�`.._ ' • ! �'I.�..,�,.>,_'.�_ f _,,. k _E LABORATORY COCKS """ MAKEUP AIR UNIT --. . _`T� __ I _I ___, i ; —. :� w : OVENLila—:.. I C POOL HEATER _ _,.3_, „ _� ` -� si{ ,��_. _. I ROOM/SPACE HEATER I . II il_ROOF TOP UNIT =-- '--'. - .- __.... z.a.,_ II_____J ' ROOF TOP UNIT $1116,'--- L____zia...____ ,.,:,,_ ., _ _ :,„_...: ,,_ , _ ___ TEST �-- -_ i �' '._,.�.is i- i UNIT HEATER _.<. I I-- .'l,. UNVENTED ROOM HEATER Ini i�.- -� - z __ at ,., .1 WATER HEATER Mr OTHER{ --- - IR .-,tilt ._J "_ INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E OTHER TYPE INDEMNITY Li BOND ...,.1 i 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 L_a SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicati are tru and cure - o the'=st of my knowledge and that ail plumbing work and installations performed under the permit issued for this application will a in com ianc with- Pertin= t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 4!/'A e.ev r 61i. LICENSE# kigt - SIGNATURE MP Va. MGF 0 JP® JGF U LPG![J CORPORATION Orft )3 ._ej PARTNERSHIP Q# LLC #- _ 1 COMPANY NAME:E�,/��,< .alc C6,-.T'�LP e. -•---!ADDRESS _?`3�._��_._ca 3Y _, __, _ _ _ -� CITY I Sp, c_ 'ran,5_w„_..__ _______ __...___,_I STATE .iu4 ZIP C''�b C- JTEL Sri 2, . 3$3 t' _____j $FAX 2"3r��Ole,610ELL ..__IfEMAIL /G_!_7CO24ry4.f(u .s% `'/'s<.,L�c�` . _-_ _�.. .___.._...._. . .._- _-.- �._� - i