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HomeMy WebLinkAboutBLDG-22-006058 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK c� CITY YARMOUTH MA DATE April 21,2022 PERMIT# BLDG-22-006058 JOBSITE ADDRESS 35 OYSTER COVE RD OWNER'S NAME David Bayer OWNER ADDRESS 35 OYSTER COVE RD SOUTH YARMOUTH MA 02664-2320 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: m 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 1 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 1 • OTHER DESCRIPTION:fire pit 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@gmail.com ImIN.mm.... .....•••••......•••••••.•••••••••• ..%•14.1.,..„ MASSA :HUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FITTING WOR.I C9-.4 0,-)>' 01 ar ----- —7—CnY 0 , .„..,. .4._ - , MA DATE 0° -Z Z PERMIT* G. JOBSITE ADDF iSS 3.5-0 ..s le A Qz)ti e OWNERS NAME p,9 ii/0 ,8/9/eF--- OWNER ADDR SS h t r r t( TB-24, 476'717,(g. FAX . . . TYPE OR OCCUPANCY 1 'PE COMMERCIAL EDUCATIONAL RESIDENMAL , PRINT CLEARLY NEW: V F NOVATION: REPLACEMENT: - PLANS SUMMED: YES eti J APPLIANCES FLOORS esm 111111_111111umplICIINUM 8 9 10 11113111101 13 BOILE . iMMIIIIIIIMII Min111111111111111. • BOOSTER1111111111111111111111111.m all 0----isly------ 11111111111M1.1111111Mom 1 OOK STOVE' 11111111.1 . . _ MIN. • DIRECT VENT HEA --TER 11111111111111 154761------- FIRS"---LAC 111111111111111.00.1111.111111M. 1111111111111.1111111111111.111111111 11111 FRYOLATOR —• inialliiii.111111111.111.111.11.1 FURNACE' Mil 1111111.....1111111111. . 1 GENERkTOR .I iiiii GRILLE 0,...1.:-.4.1111.1.1111.1.1111 INFRARED HEATER Min _ . _imam Ns LABORATORY COCKS 111111.111 - • - - - - - MAKEUP MR UNIT - MINN OVEN MIIIMMill -- POOL HEATER 1111111111.111111111111MmillitIllill ROOM!SPACE HEATER NM -11111111M11.11111110mmilliall ROOF TOP UNIT TEST 1111 aniall.0111110 • Mini...........111FAIIIIII . 11111111111111 . _ MIMI UNIT HEATER 11111111111111 • MIN. UNVENTED ROOM HEATER IIWIN 11.1111111 . • . WATER HEATER MIN _111111011.....11 . MN • . - OTHER IIIIIHIIIIIIIIIIIIMIIIIIIIIIIIMEI _ WI MIMI. _ MINI / /A'coa 7— iiiiWili - alialni MN Mallill...1111111111O 11L.0 INSURANCE COVERAGE , I have a current ftWinsuranc policy or Its substangai equivalent which meets the requirements of MGL.Ch.142 YES 1/NO I IF YOU CHECKED YES,PLEASE IN CATE THE TYPE OP COVERAGE BY CHECKING THE APPROPRIATE ECK BELOW LIABILITY 4SURANCE POLICY is/ OTHER rtpE iteabirry BOND -OWNERS INSURANCE WAIVER: am aware that the kettles gariLa,,ktin the Maulers*coverage required by Chapter 142 of the Massachusetts General I-aVat an that my signature on this permit application sift this requlrement. 17 SIGNATURE --_ GENT CHECK ONE : OWNER AGENT I herby certify that all of the Mans 1 id intimation I have submitted or entered oRny hawed; iTasircht en Oil=work and fratal eons performed under um perm Matted fort* tapprhicjion will be In and PIL of the i Code Ind Chapter 142 of the General LAWS. , PLUMBER-GASRTrER NAtt4E AI ti IREW LEIGHTON • UCENSE# 1613044 SIGNATURE AAGF JP JGF LPG! CORPORATION i 3734C PARNERsip # LLC # COMPANY NAME HALL OIL COW WY INC. ADDRESS 435 RT 134 t. CITY SOUTH DENNIS STATE MA ZiP 02850 ( TEL 508-398-3831 PAX 508-394-3068 CELL EMAIL ludbicompanyesmacarn