Loading...
HomeMy WebLinkAboutBLDG-23-001340 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ''IL 1; CITY YARMOUTH MA DATE September 13,202 PERMIT# BLDG-23-001340 JOBSITE ADDRESS 128 WEST WOODS VILLAGE OWNER'S NAME Brenda Denby I G OWNER ADDRESS 28 WEST WOODS YARMOUTH PORT MA 02675-1462 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL EI PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES ❑ NO 0 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 1 FRYOLATOR FURNACE GENERATOR GRILLE 1 • 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 1 • OTHER DESCRIPTION:piping 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 0 OTHER OF INDEMNITY El 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. PLUMBER-GASFITTER NAME 'Troy Gilbert I LICENSE# 13573 SIGNATURE MP© MGF 0 JP El JGF 0 LPG! El CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: 'COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL ' FAX CELL EMAIL Ikatherinena,coastalphc.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - i± CITY; Yarmouth MA. DATE: 09/08/2022 Z3 13tio PERMIT# �r JOBSITEADDRESS: 28 W Woods Unit 28 OWNER'S NAME:DENBY BRENDA M TR Vr OWNER ADDRESS: 28 WEST WOODS VILLAGE TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL` PRINT CLEARLY NEW:❑ RENOVATION:V REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ APPLIANCES.. FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - COOK STOVE T ' DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR ` FURNACE GENERATOR , GRILLE 1 tr} INFRARED HEATER ell LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER y.l ROOF TOP UNIT TEST ' UNIT HEATER t,U UNVENTED ROOM HEATER WATER HEATER Upgrade Gas Main to 1-1/4"Blk Iron 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY V OTHER TYPE INDEMNITY ❑ 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 CHECK ONE ONLY: OWNER 0 AGENT 0 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/GASFITTERNAME: Troy J Gilbert LICENSE# 13573 / G URE COMPANY NAME:Coastal Mechanical ADDRESS: 21 L Fruean Ave CITY: South Yarmouth STATE: MA ZIP: 02664 FAX: TEL: 508-737-8747 CELL:508-850-6955 EMAIL: Katherine@Coastalphc.com MASTER gl JOURNEYMAN Cl LP INSTALLER❑ CORPORATION❑# PARTNERSHIP[]# LLC V# 4350 E fruit.. 91)D02.c SS ,Cpw•