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HomeMy WebLinkAboutBLDG-21-000501 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0-1. O.) t=tom > CITY 'Yarmouth 7/30/2020 .,_.....PERMIT ✓ ,. .,, MA DATE JOBSITE ADDRESS! 179 Center St I OWNER'S NAME' Letters GOWNERADDRESS j scene TELL FAX! _? PRIN TR OCCUPANCY TYPE COMMERCIAL S EDUCATIONAL g RESIDENTIAL, CLEARLY NEW:',,, 1 RENOVATION:r _ REPLACEMENT: : PLANS SUBMITTED: YES NO1 i t APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 ( 14 BOILER -fit g--- j BOOSTER - l�- __. -1--1 ��_ ��0' - CONVERSION BURNER �^ { i , COOK STOVE �_ ..__ r , �-- DIRECT VENT HEATER t L_ Lam` ! _ I DRYER r m1 _ --I _ — { FIREPLACE r _.i ---1 __.__ - V v FRYOLATOR , 1 L � FURNACE j GENERATOR -- _ t _ E }i i t INFRARED HEATER __ --1____-1-" i - _,i _ _- — -- 16 LABORATORY COCKS _ �__._...--�-_-—1 t--___.a� �_�. �._..:..,___- __.._t���-.___ MAKEUP AIR UNIT - - - 1 L L OVEN POOL HEATER ROOM!SPACE HEATER _--Ir - � ROOF TOP UNIT v- l 1 ( !, . . , . TEST UNIT HEATER ..:.- I vw. _ 1� �.�� ��U r UNVENTED ROOM HEATER {�^ t , WATER HEATER �._ .,._ 1 L i t __ , e iF .: ._ OTHER �� j :. ear— I E"- ' 1 1 I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ril NO _, I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1'; OTHER TYPE INDEMNITY L.71 BOND Li' OWNER'S INSURANCE WAIVER:lam aware that the licensee does not hays 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 ;_1 AGENT Li 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. 1/_ _ L 1/_Q � PLUMBER-GASFITTER NAME!Herb Healls s LICENSE#! 20177 j SIGNATURE MP w MGF' 1 JP i JGF LPGI i CORPORATION #; t PARTNERSHIP! 1# ,LLC'_ i# __ _, COMPANY NAME:I USA Mechanical ._ _._. ADDRESS 78 Studley Rd_ _ _________ CITY S.Yarmouth ' STATE! Ma !ZIP 02664 [TEL'508 776 5495 ? FAX_. _ 'CELL% jEMAILLhhealis@yahoo.com ..__a.._ __. � ____ _ ____ _._._�_r__.. 4-411, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ;/ CITY 'YARMOUTH I MA DATE I8/4/20 I PERMIT# BLDP-21-000501 JOBSITE ADDRESS 1179 CENTER ST I OWNER'S NAME(MICHAEL LETTERA P OWNER ADDRESS 1179 CENTER ST YARMOUTH PORT 02675 I TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO m FIXTURES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING 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 m IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER TYPE OF INDEMNITY El BOND El 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'S NAME (Herbert Healis I LICENSEI20177 I SIGNATURE MP ❑ JP © CORPORATION ❑# I I PARTNERSHIP ❑# I I Lc ❑# I COMPANY NAME IHERBERT M HEALIS I ADDRESS 178 STUDLEY RD CITY IS YARMOUTH I STATE IMA I ZIP '026642906 I TEL I FAX I I CELL I I EMAIL I