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Home My WebLink AboutBLDG-23-004011 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 23,2023 PERMIT# BLDG-23-004011 .%kz•'_vr, JOBSITE ADDRESS 9 OLD CASTLE RD OWNER'S NAME CC Capital Investments G OWNER ADDRESS 19 OLD CASTLE RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Ei RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS—> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER - CONVERSION BURNER _ - COOK STOVE 1 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 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 Kevin Spry LICENSE# 15964 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: KEVIN E SPRY ADDRESS. 42 CYNTHIA DR, CITY RAYNHAM STATE MA ZIP 027671503 TEL FAX CELL EMAIL contactt7a,spryplumbinp.com ' \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 5O y= CITY .,e. l�! ► �. . , .F _�a MA DATE! I.I i I, .. ,.3. PERMIT# 23-- Li 0Z( JOBSITE ADDRESS[ - 1,, _ .s „. J OWNER'S NAME UGC b 1 ,1*.3144.4 OWNER ADDRESS • TEL!Y-S"7 ,.0 Q 51 7 FAX TYP OR OCCUPANCY TYPE COMMERCIAL° EDUCATIONAL=-1 RESIDENTIAL ? CLEARLY NEW:Li RENOVATION t 4 REPLACEMENT: PLANS SUBMITTED: YES f,,„,,,J NO APPLIANCES Z FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER g BOOSTER '�'�` � �� w ._..,,,: �_v_.�:-�� .,..,,.V CONVERSION BURNER ,r. t as } COOK STOVE DIRECT VENT HEATERr- i _,....„ _ , ._1 I/ DRYER f � �M _ FIREPLACE FRYOLATOR FURNACE ,_._ __ .� �'' ,i . x e_ -,.w_ _-_ E � ` GENERATOR GRILLE �. ..� € . 1111111, Ir 1 l ( I 1 �� INFRARED HEATER I gym_ P LABORATORY COCKS . . ' :' •SI • , MAKEUP AIR UNIT r-- , _ i gi �� ' a I a 4 4, 3Q 1 OVEN -. 4 x; is t n .�. a.. _ty!. n �...-..� POOL HEATER g ROOM/SPACE HEATER I_ € ROOF TOP UNIT - I �€,. �, TEST �� `__ UNIT HEATERIllgalaatriM. ' i 4 UNVENTED ROOM HEATER i' , _ 1 ' ' 1 � € WATER HEATER OTHER � i � � , � ate- �_�s ... .e ,+r �� ,+ j t tr - t 3'._....Ys.1 iE M ._ i .,V t'i d e 1 � ,..n. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES t NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY e.a_e OTHER TYPE INDEMNITY 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. CHECK ONE ONLY: OWNER `„ AGENT 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 compli nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws s..s PLUMBER GASFITTER NAME � ' r LICENSE# �q IGNATURE �9[ram_ MP MGF t JP,_ JGF€-. LPGI }[v_ CORPORATION #, 'PARTNERSHIP ,#I LLC)9# 3 si r COMPANY NAMEq�y � ., ..a'._.. a: , QPDDRESS ��. ,, O CITY , ° STATE ZIP W FAX_.e_ 0,51EMAIL ,. ...