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Home My WebLink AboutBLDG-23-003155 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK At CITY YARMOUTH MA DATE December 07,202; PERMIT# BLDG-23-003155 'y3 JOBSITE ADDRESS 5 CARRIAGE LN OWNER'S NAME SANDY SIDE CORP OWNER ADDRESS P 0 BOX 525 YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Erl PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO❑ FIXTURES FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 0 BOND ❑ OWNERS 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 Richard Olsen LICENSE# 10335 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: OLSEN PLUMBING&HEATING ADDRESS. 357 Hokum Rock Road, CITY Dennis STATE MA ZIP 02638 TEL 5083855290 FAX CELL EMAIL OFFICEAOLSENPLUMBING.COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK® 4c,irmourry)-)of�"Fh CITY t MA DATE _ PERMIT# 72) ( S GJOBSITE ADDRESSV Y\ , 1Y�e !OWNER'S NAME OWNER ADDRESS - J TEL! FAX TYPE OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ., RESIDENTIAL ft. CLEARLY NEW.h, , RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO APPLIANCES 1 FLOORS-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER -, ,,--31 BOOSTER '" . ` — 1 CONVERSION BURNER i ,__.- _ #n _._ _ , COOK STOVE , . 1 - DIRECT VENT HEATER ; -- 11 "1.'` DRYER i r` If . FIREPLACE [ r--•—II , i ,,, ' f FRYOLATOR i FURNACE11 GENERATOR h .� � 1 -`� -...K,'I .....r si GRILLE = if INFRARED HEATER I I -I ' t' i I} f" LABORATORY COCKS - ; i . 3or. ., . ._, ,w . . ' MAKEUP AIR UNIT 1., ._ : ' I ' I_ OVEN I. I'! ,i ° .- _i .. ; . b f Ir. II R i POOL HEATER I .._ ROOM/SPACE HEATER � i i r I,� :-- , TESTROOF TOP UNIT i I_ I _ I 1 I W T L UNIT H ... EATER E u '. . of � i m.�. �x , �P k �j� �i�—__,� UNVENTED ROOM HEATER I d - I .I °-): €" -Jr-WATER HEATER i hs ', ... "-` _. OTHER - , 1 1 it } oM INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO 17-1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY I 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. CHECK ONE ONLY: OWNER 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 t best and that all plumbing work and installations performed under the permit issued for this application will be in compliance-wi all P .in i y of theedge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Richard Olsen LICENSE# M10335 `r . ... SIGNATURE r MP I J MGF ED JP ri JGF ri LPGI CORPORATION #12166 PARTNERSHIP E..- #I LLC.71#s &HeatingHokum Rock Road COMPANYI NAME: Olsen Plumbing ADDRESS P.O.Box 2026,357 . .., CITY I Dennis ] STATE[MA ZIP 02638 TEL 508-385-5290 ----I FAX 508 385-6963 CELLS i EMAIL „1 N �%11 ( .•�� 1� _._ . _.