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HomeMy WebLinkAboutBLDG-22-0003586 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ‘irMADATE December 28,2021 PERMIT# ��i CITY YARMOUTH BLDG-22-003586 JOBSITE ADDRESS 29 REFLECTION WAY OWNER'S NAME Claire Harris G OWNER ADDRESS 29 REFLECTION WAY SOUTH YARMOUTH MA 02664-2068 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT 1-_-_1RESIDENTIAL III CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 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 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 ILESTER WADE I LICENSE# 14569 I MP 0 MGF© JP 0 JGF❑ LPGI 0 CORPORATION 0#I I SIGNATURE PARTNERSHIP ❑#I ILLC 0#I I COMPANY NAME: ILESTER J WADE I ADDRESS. 122 CAPTAIN ISIAHS RD, CITY ICOTUIT I STATE I.J3_1ZIP 026352702 TEL I _FAX I CELL EMAIL . M tSSACHUSETTS UNIFORM APPLICATION! FOR A PERMIT TO PERFORM GAS FITTING WORK _q � C171'741r Wt C t } '1 �, ZZ � I MA DATE I�-(3 -? 1 PERMIT16 TE ADDRESS .'\ 4 i c -t1 weal OWNER'S NAME Litt t'r� mod( r-i' S Sala _..__ --OWNER-AJDF SS S[c�. c,.looVc; Bij j �tf�I NG DEi'ARTIVIENT TEL 7 /�7 l t-v ie FAX uyR'PE V�'- • �. ;i.�-- ANO -'YPE COMMERCIAL J EDUCATIONAL ❑ RESIDENTIAL C`u y�'�"• NEW:J RENOVATION:!.J REPLACEMENT-ri PLANS SUBMITTED: YES❑ NO[12'' APPLIANCES 1 FLOORS- BS:4 1 ' _ I 3 �f 5 6 I 7 81 S1 i0 I 11 1 i2 13 14 BOILER i..--l;-�-y.��_�i ;;! -,--J, Y�---.t..__,i-�-�;--- ,,- BOOSItR 1 ! �- _.__, j c _u I __� it ,� i�li�-� ` 'I �( _ CONVERSION BURNER r---- r--r--' _ COOK PSI I ��—fir !-- i r-- r--- ' ; -= if f 1 I :r t �, -t, ,-- ___ DIRECT VENT HEATER I1— In--5 ; ii �-----I. -'T _il I i DRYER FIREPLACE I II ,! �' —?f— I al irIi E J J(� - ^, _0 P' `1.. il (f FURNACE Ii - t -- - ,-:_ i+__-. -- , it GENERATOR 4 ,,-==lr_. is -- -"1: ---g---l• - GRILLE i '1 — f-- --=i- iI _ !i�` ;. : e �,'j I INFRARED HEATER � I —1— `i ;I Ia ;1 IF ..I —i1 -p .f n LABORATORY COCKS E --� •-.� `_--�I•--=-,-=:=- ---':-_..,-. :. -_'. MAKEUP AIR UNIT Ir-i _II -krill iI.. '-�L.. fI ii .� 1_._._11 OVEN Ir—�I- a il�-i�--_,r-- 1 _. _�_._f__.- ..i�POOL HEATER, t -, •=r_- ,.--- _ _1—.._;L�_ ._; ._._I' - _I_- it =•h�11 1� !1- 1 --- , a i ROOtvi t SPACE HEATER I I 0'11,-`- T 1 ROOF TOP UNIT I :__ 11 -1 —�� r I'__.-._.�r� 'I I TEST ,f it -- '? (�-L _ _ ___: UNIT HEATER ��. _ . _ ., i t� ( _ w iI � . UNVENTED ROOM I �I 1_ Li ._ :t ; §I--.ti-rl.. ;;, 1' ~ M HEATER —'I ( "� - � WATER,HEATER k y ..�. ,. ,� _ _. ..__Y�, ` OTHER I iF-(--1 `1 _1.,_ ', _~'-ir 2 -` t st ' - l,, ..._,f Jg til z lr—,1 - I 1'I. �i `I -y INSURANCE COVERAGE `� ` ' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES [5NO _ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY II I 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. CHECK ONE ONLY: OWNER I I AGENT - SIGNATURE OF OWNER OR AGENT t 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 co plian e,vith all^e tinent provision of the Massachusetts State Plumbing Code and Chapter•142 of the General Laws �j/ le PLUMBER-GASFfTTER NAME +ref ' cry. I (,TURE -- i r s' �'�'CCcf 1 LICENSE T'�¢5�1Ci SIGNATURE MP- MGF IV JP El JGF LPGI ri CORPORATION 041PARTNERSHIP — l I Irf ( • LLC T — COMPANY NAME:IC;le Cori •u4. .0e,-t<<i'.e.. --askAppRESS I :3..3t c:;s,L:eL,?aZn f"�..:• cm' Is►.'tasis ,� l • I .^ e._ I STATE WI- I ZIP I aaf.,-c(J I T EL - `¢-)?-- §" `S.3" FA.t i I CELLI djc 57. IEMAILi ,ift 5 ' C • �c`p,C��'.�t,c�.r z;:-re H , c,••. S.'