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HomeMy WebLinkAboutBLDG-21-002925 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k-9!Cr-Z- CITY YARMOUTH MA DATE November 20,202( PERMIT# BLDG-21-002925 JOBSITE ADDRESS 27 SIBLEY DR OWNERS NAME CREEDON VINCENT G OWNER ADDRESS DRISCOLL ALICE 19 POWDER HOUSE ROAD EXT MEDFORD MA 02155-2911 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL El CLEARLY NEW: ❑ 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 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 ❑ 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❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD, CITY COTUIT STATE MA ZIP 026352702 TEL FAX CELL EMAIL 1 MASSACHUSETTS UNIFORM APPLICATION! FOR A PERMIT TO PERFORM GAS FITTING WORK R' y CITY I v(Cc r vvv o a41I MA DATE I I l-6->c a o 1 PERMIT# W� JOBSITE ADDRESS a1 S i to I e �.! l Dc. I OWNER'S NAME v tip - •i i' Co e t' o, l rT OWNER ADDRESS S(ct, ct.loo4Z TEL la1-'itaO•- t`t 4" FAX PE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL n RESIDENTIAL[0''' PRINT kily � }� NEW:13Z RENOVATION:❑ REPLACEMENT' ❑ PLANS SUBMITTED: YES❑ NO APPLIANCES 1 FLOORS- BSM t j 2 ( 3 L 4 I 5 1 6 1 1 1 © I 9 10 11 I 12 13 14 BOILER li--�1 r_._Il ' ;�-il {_.. -- r_ - --._.. _ BOOSTER ' i1 (i I ----:r--1 i---�1 r Ii 7 t r 4 _ l CONVERSION BURNER -1 -- - 9 ... COOK STOVEti a ! ((- � �( _( . - II DIRECT VENT HEATER (- f--4 �1 t .I 1 I ` I i' — -. -_ - ] DRYER II L j ;I fl-- , !f.- IL t(---=,,_ t I n'' FIREPLACE �' ;, --� FRYOLATORre--- . �-- --- ' —: i1 1 _- s f FURNACE ...III- -. . ((- (— f( . � _ ,-----If •r J t I _ II - if __ I GENERATOR , ---, �-..�0 If=____;-- ' _-.1I- _1� I�_ _:r.__ _��}'.---LI I GRILLE i --=;--=-� 'u l_ " _ .. 't . 1 f i INFRAREDHEATER �(� r�—� 1 ;i l ;; rlI I - :h , f r l ii _y. �L �f 1 11 '! 1 h LABORATORY COCKS �i _-1 - `-11 '-�-- --•- -'= I e .__ ( .r4. .. MAKEUP AIR UNIT Ij`--:f U--------A----I1--tri --4 I f[-�r----j ,�-_ - __ OVEN F HL _fl _i..__J_ . ;! . it I, L_ - , . P t POOL HEATER - ,—=--, t ROOM/SPACE HEATER a `� + ,� i _ ROOF TOP UNIT I {I I t, Il Mil—iI .'f r i t - - �' TEST . . _ HEATER '.... _ ; ..tiL i+ 7 _,i-, __ i i _ t S I UNVENTED ROOM HEATER ( - -',f .;1 ( ....."`.3.`...__,:..w....1 .:''�--4. ' WATER _ a HEATER —`.1 . :' I. �. ' I.._ t., I ,, 'vr 17 OTHER _ 11 i r r,_ _ i i aY ,41 Ii'1SUR.ANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements or Iv1GL.Ch. 142 YES [rNO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 OTHER TYPE 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. 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 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 pliance all pertinent provision of the MascArhusehs State Plumbing Code and Chapter 142 of the General Laws /p1JtI`(!� PLUMBER-GASFITTER NAME Le54cr Wetet& LICENSE#f is c-,Cj 1 SIGNATURE MP(-7 MGF rOr JP[ JGF_ LPGI[] CORPORATION -T( 'PARTNERSHIP[141 I LLC CA— I -1 COMPANY NAME:IC&p L S e' en RiliAppREss CITY I114a_5l;tper_ I STATE MA %JPI o t;tt(7 ITELIJO 'ff71- 7 I FAX I J CELL{5jc?gy'. 51)_ EMAIL th. e.', Ct, ' 'J l p e.ki Y " i-`:i G•et i4 -------- ,...., NOV 10 ?=� 1 ' I (0/ BUILDI 0 By: