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Home My WebLink AboutBLDG-23-001978 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 13,2022 PERMIT# BLDG-23-001978 JOBSITE ADDRESS 24 THEATRE COLONY LN OWNERS NAME Savannah Luke G OWNER ADDRESS TEL _ TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL❑ PRINT CLEARLY NEW: m 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 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❑ 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 'Mark Watson LICENSE# 3842 SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME: (MARK D WATSON I ADDRESS. 181 CAPTAIN PERRY RD, CITY 'BREWSTER ISTATE MA ZIP 026312559 TEL I FAX I I CELL EMAIL pieman83WcomcasLnet f 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 MASSACEIUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • 1 .ti\G L) y-\___ MA DATE V / 2 Z PERMIT Z 3 !`7 7 JOESITE AO:RE.SS �' f C 1 11 L_ �G C( \ () 0 1 1� % 1��OWNER'S NAME- U f�i�� !d (77 CT WIIR4DDRE S TEL FAX".I -` '-WC D e€UR,hN�1'Ti PE COMMERCIAL ! ptii-NT 1 ❑ EDUCATIONAL ❑ RESIDENTIAL Er" NE'W: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES T FLOORS SSM 1 3 4 5 6 9 10 II 12 I; 1� BOILER - ° BOOSTER CONVERSION BURNER COOK STOVE _ , DIRECT VENT HEATER 1 DRYER FIREPLACE FRYOLATOR FURNACE i GENERATOR D U S`t C e , GRILLE r-- INFRARED HEATER LABOPJATORY COCKS I —� i MAKEUP AIR UNIT I OVEN POOL HEATER ROOM/SPACE HEATER — ROOF TOP UNIT — I TEST -. UNIT HEATER UNVENTED ROOM HEATER WATER HEATER — OTHER - I 1 INSURANCE COVERAGE I have a current liabill insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES a NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE.TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW / LIABILITY INSURANCE POLICY Cr OTHER TYPE INDEMNITY ❑ BOND ❑ • OWNER'S INSURANCE WAIVER: I an aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1• Massachusetts General Laws,and that my signature on this permit application waives this requirement, . CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGE NT I hereby certify that all of the details and information I have submitted or entered regarding this application are true d 'i'cur ,to t e s 10 and that all plumbing work and installations performed under the permit issued for this application will be in co .with e nohe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. o isio f the PLUMBER-GASFITTER NAME vI \ RK 0 L )A S 0 IU LICENSE#e? /L SIGNATURE MP I I MGF L.J JP ❑ JGF❑ LPG; ❑ CORPORATION ❑4 PARTNERSHIP❑# LLC❑# ( COMPANY NAME lA k1 l-k•K S -U N t S{3R\J i(C..._ ADDRESS 8I C]A\ 1 9cc Ir y 2 0 CITY iA.) ,,) Vr-- a 2//� 3 �7 STATE `!kJ( 6 4 ZIP 6 1 c� 7 T L FAX CELL 1 ?Y' 1l'� ' ( T I i EMAIL e % C CJ 3 s -, Cc'I•ti7 C-LC S 1 , =v-'C I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT ft PLAN REVIEW NOTES