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HomeMy WebLinkAboutBLDG-22-001525 _,A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK d� -' CITY !YARMOUTH MA DATE September 16,202 PERMIT# BLDG 22-001525 1; JOBSITE ADDRESS 66 MAYFLOWER TERR OWNER'S NAME 'Chris Speers I G OWNER ADDRESS 66 MAYFLOWER TER SOUTH YARMOUTH MA 02664-1117 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0 FIXTURES FLOORS—3 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 'Stephen Winslow LICENSE# 112298 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: !STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, CITY IS YARMOUTH STATE MA ZIP 1026641207 TEL ' FAX 1 I CELL ' EMAIL Iinspectionsna.efwinslow.com Y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' 715.9I= 4 CITY YARMOUTH MA DATE 9/9/21 PERMIT# JOBSITE ADDRESS 66 MAYFLOWER TERRACE OWNER'S NAME CHRIS SPEERS GOWNER ADDRESS 651 EAST 14TH STREET,APT 3-D,NEW YORK,NY I TEL 5083988739 JFAX (`` PRINT _TYPE OR OCCUPANCY TYPE COMMERCIAL! EDUCATIONAL 1J RESIDENTIAL EjCLEARLY NEW:U RENOVATION:ID REPLACEMENT:I.,. PLANS SUBMITTED: YES rA NO APPLIANCES 7 FLOORS-0BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 p �•� F F BOILER ...__ ' _ ai� BOOSTER CONVERSION BURNER I ,, . . COOK STOVE I I.:m,. w . DIRECT VENT HEATER _ 11U111.11_01111111.11111; " ` DRYER ` a l .I In FIREPLACE 11.11111111 MMO—11MM11.1110 MO 10.1111111110.1•11-0111 S' FRYOLATOR V' FURNACE ¥ 1. ,iffil :OM i GENERATOR NM '. GRILLE ..M, INFRARED HEATER ,— aT.. LABORATORY COCKS MAKEUP AIR UNIT immitimaii ri__----- OVEN POOL HEATER . . `' ROOM/SPACE HEATER i ROOF TOP UNIT ` !IMIIIIOIRIIIIIIOIIIIIIIIIIIIWI —. TEST Rl UNIT HEATER ON _„ _ - UNVENTED ROOM HEATER WATER HEATER11111.111111.1111-0191011101HIMOMMINNIMMOINION OTHERM ... _._w :i MiligillinienalrintIONAMOIllilaillMOINIMINIR F' INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO l I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Pj OTHER TYPE INDEMNITY LiBOND 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 El AGENT 0 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 accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc ajYPp .rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1' ». • r. _ ". --- PLUMBER-GASFITTER NAME I STEPHEN WINSLOW �LICENSE# 12298 SIGNATURE MP MGF JP JGF 0LPGI[„J CORPORATION #€3281C __PARTNERSHIP # h _ LLC # COMPANY NAME:CE.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE II MA _I ZIP 02664 1TEL[508-394-7778 FAX I 508-394-8256 CELLI N/A EMAIL SPECTIONS@EFWINSLOW.COM _ _ —_