Loading...
HomeMy WebLinkAboutBLDG-22-003305 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK * M CITY YARMOUTH MA DATE December 10,202'PERMIT# BLDG-22-003305 C JOBSITE ADDRESS 29 SUMMER ST OWNERS NAME Sarah Hinkley G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS-» 8SM 1 2 3 4 5 6 7 B 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Stale Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LESTER WADE LICENSE# 4569 SIGNATURE MP 0 MGF©' JP❑ JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME. LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD, CITY COTUIT STATE MA ZIP 026352702 TEL FAX CELL EMAIL S31ON M3IA32J NVld #JI1A11:13d $ 33d ❑ ❑ 1I1183d 3H1.Sd S3Ael3S NOLLVOIlddd SIHl oN saA S3±ON NO1133dSNI 1VNl3 AINO 3Sfl 1OI33dSNI H0139Vd SIHl S3ION NO1133dSNl SVO HJf102i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMFI TO PERFORM GAS FITTING WORK %; CITY yral,r &oi,. -�'� ��' MA DATE t ~�C-� I PERMIT - `33 JOBSITE ADDRESS, a61 SU,v viit at, OWNER'S NAME i Saf&i 4-64A-Cie.tec .l if .,,A Tr; OWNER ADDRESS S a_ cLIQ o V 2. TEL cl l 1-37 N -O 75-- FAX , ' OR . OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL n RESIDENTIAL • x RENT. "'` �Y NEW: RENOVATION: 1 P,EPLACE1viENT. fl PLANS SUBMITTED: YES 0 NO( APPLIANCES 1 FLOORS-- BSM I ( 2 3 .I ( 5 I 6 7 8 9 10 ' 11. I 12 13 1a BOILER -1-' :, 11 ..._1: i f—f-- I I'. BOOSTER ER - :r if — ''i Iii �!Ir,�IF----- CONVERSION BURNER. r" _,I r _jF__ ..-- :'..1;r___---1-1----_ , I tJILir _= .__. j;COOKSTOVE 11 —� 11 ,! ll DIRECT VENT HEATER II �� !:_____,, -�.�4 !�.. .._ f�—r:1r __- !__::rzTTx } DRYER II� . ..... 'll 1�- -1�... ��_�; {__ . .t.__ , FIREPLACE --t r3- -'Y - .i,. 41t -r -.:--' ..-`'rr_� -rY�:;— --._c' FRYO L T n _ - r I . _ .__ .__ _..1 __.._ FURNACE I �I~ ii , •r, ! y l- " _. _:_ _ (:... -II�-- �+« GENERATOR ._.__ -✓ 4 --_-- h _ ,i___ „ r.if ii- F -i--- - r- ,{==-i- ----- is g GRILLE II 4 ; __-_-..,,.:;_ 1 in',.; �� -._.. 11. INFRARED HEATER i 1 "r l _ _�/�._. __� '_ '' 7l �_.��:. ...�.J LABORATORY COCKS ,y--- 7---- k-'=--;; ""�' '; I; { I ! MAKEUP AIR UNIT II- i( --II r f II �. . F . ., / - I ti OVEN r •a�• . . iL ---� i .�-ems I 1 POOL HEATER E •+ I1- ii _ _ i: 1. . ! ;i II `i ROOlv1 / SPACE HEATER I '{I L`i ' _,_ 11 t. ja 1I l .21 __. � .. I 3 ROOF TOP UNIT TEST a ...,...:t._.._ �I �.# ,. __�. . .i y...�... r..._...,._.,r-i1 , _.� 4 iI ,._._-.r, ....._ l._....._.1 1 UNIT HEATER I _ 3I ,„ �..4._,... `' t ,1i_..... .L-_...,..: .. ! ---.":7; UNVEN T ED ROOM HEATER (� l 1, I- _i'1 .IY_ ;; n _ a s •. =t: '=- ".....d...: -..•...,_�,C.. •...�_- r -- - -ate _. ;�e�-::c� -ram WA T EP HEATER tt�yy—{ Ti-- == i; —:r ii ,1 1__ - ` 1 ,'�a_4;_•.__-_.sti.--z _.wr 4 -- :i :-..r.�ii —r. -1• .-s-iI- ---- —_.i .ram....i —y -_..• i OTHER I[ jf___ _ 4 :: : L �'� � , ...I . 1 — `.: - _IL ! ir—ii !-, . ..: . .1r---,„ _. =, !. I—Tr{ 0 -1— I! it , I. ._-_ I __ �. - _ �I !-. ..a. w3i+____ �I . wit ..N.... -.. a-...t_._. .".-_ •J.___ • _• 11.f_._._..._.. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [ NO [j I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BO;; BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 1 I BOND I-I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b' Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ( AGENT E 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 ssued for this application wilt be in co pliance with all Pe t'nent pjovislon of the lvlassachusetis State Plumbing Code and Chapter '142 of the General Laws ' Ji J e,--- PLUMBER-GASFITTER NAME ! Le54c (A)Gt.et- j LICENSE TI i} ci SIGNATURE MP ___. MGF (1/ JP E] JGF 0 LPG' E CORPORATION 0# I PAR,T NERSHIP 04 , LLC 4 COMPANY NAME: (Lee cz'(( t ,.z.. e•ut.e,i+- pr PRESS Q 3 xx,,tc iv, ...._..q • CITY , MA e c„.. • STATE ATE { MA ZIP o atm, q 7 i cL 1 SLR '- tf77- r `6'. 13".7 FAX I 10ELLJ5V - El1AILIrt a . GCr �-