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HomeMy WebLinkAboutBLDG-22-003416 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _k ° .=c CITY YARMOUTH MA DATE December 15,2021 PERMIT# BLDG-22-003416 JOBSITE ADDRESS 82 CHIPPING GREEN CIR OWNER'S NAME HAMMOND WENDY M G OWNER ADDRESS C/O BROWN RAYMOND 10 ANDREWS DR UXBRIDGE MA 01569 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ 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 BOOSTER , CONVERSION BURNER , COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE . FRYOLATOR , FURNACE , GENERATOR 1 , 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 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 LESTER WADE LICENSE# 4569 SIGNATURE MP❑ MGF © JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: !LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD, CITY COTUIT I STATE MA ZIP 026352702 TEL FAX I CELL EMAIL I t+F!ASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,V CITY I yp rv►-k�,u,�L, MA DATE�1�-(e- pERtv11T ZZ ' 3`7((. JOBSITE ADDRESS i 1-4.. (h;to p;,iei Crree t1 C;r, OW ER's NAME (Z F 13 ell-5 '` a OWNER ADDRESS ! Sta.. cLlooV 'T'a'PE OR 'TE 150.6-39W-ya 8a, FAX }°R �,t OCCUPANCY TYPE COMMERCIAL7EDUCATIONAL RESIDENTIAL • NEW: RENOVATION:E P,EPLACEfv1Et4T ❑ ! APPLIANCES 1 FLOORS-, ! PLANS SUBMITTED: YES 0 Np� BOILER F MI © 2 3 4 5 8 9 BOOSTER ' I �i .- to - 6 _ � _ � - - ;_ ` 13 14 i f j t-�--=T.—r-- I CONVERSION BURNEP. 8 r q -- 1 1 i COOK STOVE — -7 i — e I ld DIRECT VENT HEATEP, (--. ^4 II ' S _ DRYER <�- (---( ( 4_-- --i_ � FIREPLACE I - - - -��-..._.�- r.— (___-1`-.—: (�_ FRYOLATOR - _ r �, FURNACE GENERATOR A - --__ � i- i GRILLE :i4:7. _-- _ _._ -I INFRARED HEATER t `I `' --1 1� 4 :. ' LABORATO t I �� i t r LABORATORY COCKS ' "�'-"� MAKEUP AIR UNIT �� :nil 'b z i - K ---- OVEN ; ! '' -� _ POOL HEATER - C ROOM/SPACE HEATER I 'f—1-=- = -- -te --y r , —", 1 F ROOF TOP UNIT 1( � I_ _ �,! � �-� _-�jj �---,,- . f--- TEST _ UNIT HEATER - � _. & . ... . . - ---1 .-._.. __..,__ �_I UNVENTED ROOM HEATER I __ I .-"it 'g` ~-' '� 9 _` WATEP, E 3 HEATER I .._,__,I _.=i..,—..ffi. .„a_� _� ;; L. � OTHER it 1 _ I. INSURANCE COVERAGE 4 — _ r _ _ t I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i= 'VO LIABILITY INSURANCE POLICY r OTHER TYPE INDEMNITY 0 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 requirehenL SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 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 AGENTn and that all plumbing work and installations performed under the permit issued for this application will be in co liance+ ' Pe-' t Massachusetts State Plumbing Code and Chapter 142 of the General Lawsof my knowledge P n3h all� _.n_n p vision of the PLUMBER-GASFITTER NAME �,25 i. 1�1.!CLc(z .�t4: Ci6' LICENSE� +�� i SIGNATURE MP❑ MGF 4 JP E JGF— LPG!0 CORPORATION �� " I ❑ PARTNERSHIP[]4-7 LLC[ln-- COMPANY NAME: ) �,� �i�,f _ d.=ae t&ra±arivaaRESS Q3 go.vc[ta eh �S-1. STATE I MA Ma.5(4 ?? A• JP 0 TEL L5v E_ 7?-- ' FAX ft-- -----.I ELL150a. 57)- JEMAIL tl Cc. '