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HomeMy WebLinkAboutBLDG-23-001913 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 01 `4 CITY YARMOUTH MA DATE October 11,2022 PERMIT# BLDG-23-001913 • tC JOBSITE ADDRESS 60 BROADWAY UNIT 12 OWNERS NAME THE TIME SHARE ESTATE TRUST G OWNER ADDRESS 1 ARDELL RD BRONXVILLE NY 10708 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE • GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/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 11 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP 0 MGF ❑ JP© JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY (West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL Istinger.mcbride(a),gmail.com �� 'anp�.a��HUSETTS UNIFORM r� r _ APPLICATION FOR A P RIIRIT TO PERFORM GAS FITTING VVQRK ~ CITY~ •�. • "Ti'''. T �) ?Y _i r Li ;_ W MA DATE i ' PERMIT# Z��y l 3 JOEb A ID- SS a ;wG D, gkok OWNER'S NAME fLE1D z SS TYPE OR S — 3 FAX Y PE INT CLEARLY OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL(� NEW:0 RENOVATION:ce REPLACEMENT: Vj APPLIANCES 7 FLOORS-+ PLANS SUBMITTED: YES❑ NO k BOILER ---0�©©a®© 10 BOOSTER -��--� ®® 13 14 BOOSTER CONVERSION BURNER -� --� =MUM ��-- -� RECT VENT f!EATER III -mi��_- -- DRYER —�_-_ ----�-- FIREPLACE �_ � —_—�—�� FRYOLATOR -- _— �� allumulti.rannualliralari GENERATOR � INFRARED HEATER —ilMIIIIIIIIIIIIIIIIal �--� ��_— LABORATORY COCKS -__�_ --_S- MAKEUP AIR UNIT _r— _—__�_-- POOL HEP.TER _—n_— Mill ION 1111111______11111 1 IIIIIIIIIIIIIIIII -__onmol ROOM/SPACE HEATER =---- __�— ROC)F TOP UNIT 11.11111111111111111M ___ =—_—_�— - uNwr ®�®®�®�eiis��� �� UNVENTED ROOM HEATER MIN ____ —====� WATER HEATERIlliallil—_r=_--- _-- OTHER ���_�-� �_� �-___- ��__-� ------_ __ _--- 11111111111GE 111111111111 have a current liabiii insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE42 YES El NO 0 LIABILITY INSURANCE POLICY IX BOX BELOW OWNER'S INSURANCE WAIVER:I am aware that the licensee doesOTHER TYPE INDEMNITY ❑ BOND ❑ t have the insurance co Massachusetts General Laws,and that my signature on this permit application waives this revurage required by Chapter 142 of the qutretnent. J • SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER `b I hereby certify that all of the details and information I have submitted or entered regarding this application aree 0 AGENTto the best of my 0 and that all plumbing work and installations performed unhave rs the ,�' Massachusetts State Plumbing Code and Chapter 142 of the General Laws.it issued for this gis application will be in compliance with all tPerti Pertinent provision of e� PLUMBER-GASFITTER NAME A Cii21 I (16 tC(eL /LICEN E" MP 0 MGF 0 JP / t GNAT JGF❑ LPGI 0 CORPORATION 0# COMPA VY NAME PARTNERSHIP El# LLC❑# CITY ADDRESS iq n STATE, V� SIP Q21_ . FAX TEL CELL EMAIL 1 mr - • .,. !-