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HomeMy WebLinkAboutBLDG-21-006808 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 24,2021 PERMIT# BLDG-21-006808 Li_�. JOBSITE ADDRESS 10 CROSS ST OWNER'S NAME bill wells G OWNER ADDRESS NEEDHAM MA 02494 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 GRILLE 1 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❑ 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 0 JP 0 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 Ihalloilcompany@gmail.com I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES <- c..<- _5—% , _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY S 9 g A ie-t c,c., i, t MA DATE 6 / / PERMIT JOBSITE ADDRESS (CJ C 72 v s S , 7- -OWNER'S NAME /3.// (-'Jc'//1. -- OWNER ADDRESS !f TYPE OR TEL //.- ,,73).-% 4AX G p -2 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: 7. RENOVATION: REPLACEMENT: - PLANS SUBMITTED: YES NO 1/- APPLIANCES 1 FLOORS—. BSM 1 2 I 3 4 5 6 7 1 8 9 id 11 1 12 13 I 14 BOILER BOOS I bI • . _ -j CONVERSION BURNER ' - COOK STOVE f I DIRECT VENT HEATER # I f ! DRYER FIREPLACE • i . FRYOLATOR I 1 1 I I I 1 1 I FURNACE •I (- .. .- . . I I I I GENERATOR f - I . I I - -I I f GRILLE I X I I I I INFRARED HEATER _ LABORATORY COCKS I .- I MAKEUP AIR UNIT OVEN I , ,.I i • - _ t.-POOL HEATER I t - ROOM/SPACE HEATER 1 _ I ROOF TOP UNIT I - I TEST UNIT HATER UNVENTED ROOM HEATER I I WATER HEATER • - I OTHER I -I 1 I I I I - 1 I I I I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES t/NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V 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. SIGNATURE OF OWNER OR AGENT CHECK ONE 0 Y: OWNER AGENT I hereby certify that all of the details and info.nrmicn I have submitted or entered recording and that all plumbing work and installations perforated under meop i isbeapplication are a and b or my of the knowledge Massachusetis State PlumbingChapterpermit Issued for this appJioafion will in piian ' it P rti an of the I 1 Code and 142 of the General Laws. c/ PLUMBER-GASFJTTER NAME ANDREW i EiGHTON L1Ca=PiSE# 16130.Pd SIGNATURE I MP ' MGF JP JGF L1='GI CORPORA-NON r m 3734C PARTNERSHIP # LLC # COMPANY NAME HALL Olt.COMPANY INC. CITY SOUTH DENNIS ADDRESS 4-35 RT 134 STATE MA ZIP 02880 TEL 508-398-3831 FAX 508-3943068 CELL EMAIL nalloilcompany@gmaii.com i A.i_C/� fn (t C✓ Cc-Ci(},,,,Ter1 J-r`4.'//S e fJ/t/UC-7- .00-C