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HomeMy WebLinkAboutBLDF-23-001868 #594 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' CITY YARMOUTH MA DATE October 07,2022 PERMIT# BLDP-23-001868 n tP JOBSITE ADDRESS 590&604 ROUTE 28 OWNER'S NAME KOPLOW STEVEN TR G OWNER ADDRESS RK REALTY TRUST PO BOX 489 BROOKLINE MA 02446 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© 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 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 CI 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. 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. ILICENSE# I13417 I SIGNATURE PLUMBER-GASFITTER NAME (r checkoway ,0#i ILLC CI#1 MP© MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION CI PARTNERSHIP# I COMPANY NAME: I I ADDRESS. 111 scarqo hill rd, I STATE IMA I ZIP 102638 I TEL I CITY Idennis FAX 1 1 CELL 1 1 EMAIL 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,r w el ,r CITY W YARMOUTH 1 MA DATE; 10/4/22 ; PERMIT# Z 3_ /g I JOBSITE ADDRESS!594 ROUTE 28 _j OWNER'S NAME I PRACHA_SOMKITCHAROENw _ j GOWNER ADDRESS 1 BASIL THAI CUISINE y TE 508-280-0893 ANN JFAXI __ ._ TYPE OR OCCUPANCY TYPE COMMERCIAL L EDUCATIONAL,_._. PST RESIDENTIAL CLEARLY NEW:Li RENOVATION:L i REPLACEMENT:!_,,,,1 PLANS SUBMITTED: YES Li NO;,,, APPLIANCES 7 FLOORS-► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER i . -I 1 _._ J1 .__ --s_.t._.�_I _�,_____11-—11-1-1—- � _., 4y_ I .� CONVERSION BURNER I � i _ __ r COOK STOVE I�.. 11 C _ — . DIRECT VENT HEATER '� '1 — r-- " i r [" r� ' DRYER ��__.__' _ 1 �.,,�__. .__ .�� . �.__. �� - � � d - FIREPLACE FRYOLATOR illilidlit T , 4, , I FURNACE , GENERATOR Ti ,„ , , ___ r GRILLE ( _.._. 1 �i .� ; .� � _ INFRARED HEATER LABORATORY COCKS f 'r l; R _ f. MAKEUP AIR UNIT r _ I I I _-_ -11,..._,.. . OVEN ;o POOL HEATER"" e ..I ROOM/SPACE HEATER r ' ._ .__ °' _ .I 111111. 11---- ROOF TOP UNIT 1, -- _ - - __ TEST I ., UNIT HEATER . [n jL-' ! i ,. _ F- I ri r UNVENTED ROOM HEATER r WATER HEATER_ . 1 OTHER Tarm INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LA NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY +I OTHER TYPE INDEMNITY BOND 1 ' 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: OWNE: .. 1 AGENT T 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 o e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia - wit - inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I R Peter Checkowa LICENSE#I 13417 . c MP__/_J MGF _ j JP IL1 JGF Li LPGID CORPORATION,')#' PARTNERSHIP LLC # COMPANY NAME,Checkoway Enterprises ADDRESS! 11 Scargo Hill Rd CITY , Dennis STATE; MA ZIP!02638 TEL 508 3851911 i I :FAX,508385 6858 , CELL 508 735 999�EMAIL checkentcomcastnet Ie_ a _