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Home My WebLink AboutBLDG-22-001788 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " CITY YARMOUTH MA DATE September 28,202 PERMIT# BLDG 22 001788 JOBSITE ADDRESS 179 CENTER ST OWNERS NAME Mike Leterra G OWNER ADDRESS 179 CENTER ST YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 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 1 POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 . 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 El 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP 0 MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION El# PARTNERSHIP 0# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa a(�coastalphc.com `` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11:41 fir CITY !Yarmouth Port MA DATE 09/23/2021 PERMIT# 21- 11 f I JOBSITE ADDRESS 1 179 Center Street-MAIN HOUSE I OWNER'S NAME 'Michael and Leslie Lettera G _ w. OWNER ADDRESS 2001E 2ND Ave Unit 10C-TamPa FL 336005 i TEI TYPE OR FAX......W,.... PRINT OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL El RESIDENTIAL El CLEARLY NEW: RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES® NO D APPLIANCES 1 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 IIREARRIMMINMENRION DRYER FIREPLACE NMI MI FRYOLATOR s :` ., _ .. FURNACE , GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN m p = r 1 POOL HEATER ROOM/SPACE HEATER aii ROOF TOP UNIT am Es an �en mapmam ammi ant TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE 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 CHECK ONE ONLY: OWNER 0 AGENT 0 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 TroyGilbert /4. a , LICENSE# 13573 /j' SIGNATURE MP 0 MGF 10 JP 0 JGF 0 LPGI 0 CORPORATION D#1 PARTNERSHIP 0#f JLC 0#J 4350 COMPANY NAME:(Coastal Mechanical 1 ADDRESS 121 L Fruean Ave CITY 1 South Yarmouth i STATE' MA ZIPJ 02664 TEL 1508-737-8747 FAX' . CELLI508-850-6955 EMAIL Iisa@coastalphc.com