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HomeMy WebLinkAboutBLDG-23-003339 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY IYARMOUTH MA DATE December 15,202; PERMIT# BLDG-23-003339 tI JOBSITE ADDRESS 125 MAUSHOPS PATH 1 OWNERS NAME (Anne Venditti G OWNER ADDRESS TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 El 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 'Charles Stockdale I LICENSE# 124526 I SIGNATURE MP❑ MGF 0 JP© JGF❑ LPGI ❑ CORPORATION 0#I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: 'CHARLES L STOCKDALE ADDRESS. 1256 MAYFAIR RD,256 MAYFAIR RD CITY SOUTH DENNIS STATE IMA I ZIP 1026602803 I TEL ' FAX I I CELL I I EMAIL Iclsplumb(a�gmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0 CITY Yarmouth MA DATE 12/11/2022 PERMIT# 2-3 — 333 ? JOBSITE ADDRESS 25 Maushops Path OWNER'S NAME Venditti , A-NNE GOWNER ADDRESS same TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-4 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 OTHER gas log 1 INSURANCE COVERAGE • I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I ' 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 I OWNER'S INSURANCE WAIVER:lam 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 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 . .f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com Perti _ .•. r: • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,' / / PLUMBER-GASFITTER NAME Charles Stockdale LICENSE# 24526 1 IGNATURE MP MGF JP / JGF LPG! CORPORATION # PARTNERSHIP # LLC # COMPANY NAME: Charles Stockdale ADDRESS 256 Mayfair Rd. CITY S.Dennis STATE MA ZIP 02660 TEL 508-398-2843 FAX CELL 774-208-1613 EMAIL clsplumb@gmail.com w a+t 12/11/22,11:14 AM Accepted Plumbing Products Online System by Massachusetts Board of Registration of Plumbers and Gas Fitters Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies Home>Division of Professional Licensure>Board of Registration of Plumbers and Gas Fitters> ONLINE SERVICES Accepted Plumbing Products Online System eoiace rortai Y Contact the Agency By the Division of Professional Licensure Table.ONLINE PLUMBING PRODUCTS SYSTEM: SEARCH RESULTS Search Criteria: There are 1 1 record(s)in our database Type: Gas fitting your search criteria. Please note that Manufacturer: Hargrove Mfg.Corp, if your product is not displayed in the Product: search results,you can refine your search Model: 24CNFH1T1 criteria. Description: Displaying page 1 of 1 search results New Search pages Requested products per page: 50 PRODUCT, DESCRIPTION, MANUFACTURER MODEL ACCEPTED APPROVAL APPROVAL CONDITION CODE FIRESIDE TECH 9000 BURNER 24"TECH 9000 BURNER WITH 3N1 Hargrove Mfg. VAVLE NATURAL GAS Corp. 24CNFH1T1 9/6/2017 G1-0917-58 First Page I Previous Page j Next Page J Last Page