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BLDG-23-001630 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 27,202 PERMIT# BLDG-23-001630 JOBSITE ADDRESS 178 SPRINGER LN OWNER'S NAME HUGHES THOMAS J JR G OWNER ADDRESS HUGHES PATRICIA M 178 SPRINGER LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 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 1 OTHER DESCRIPTION:outdoor firepit 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 12 OTHER OF INDEMNITY❑ 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP©MGF 0 JP 0 JGF❑ LPG'0 CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME: 'COASTAL MECHANICAL I ADDRESS. 121 L Fruean Ave, CITY IWAREHAM I STATE MA ZIP 025711324 TEL FAX CELL EMAIL Ikatherineo(T,coastalphc.com S310N MJIA32! NV1d #1IW213d $ :33d ❑ 0 111AIa3d 3141 Sb S3A 3S N011'd3IlddV SIHl oN saA S310N NO1103dSNl 1YNl3 )llN0 3Sfl 80103dSNI HOd 30Vd SIH1 S310N NO11O3dSNI WO HOfaf MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4r `'` e ►=! CITY: Yarmouth MA. DATE: 09/22/2022 PERMIT if 36 i JOBSITE ADDRESS:178 Springer Lane W.Yarmouth MA 02673 OWNER'S NAME: Tom Hughes OWNER ADDRESS: 178 Springer Lane W.Yarmouth MA 02673 TEL: FAX: a TYPE OR PRINT OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ' .4- CLEARLY NEW:, ' RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOOR-. Bsmt 1 2 3 4 5 6 7 — 8 9 10 11 12 13 14 • BOILER 1 BOOSTER ' CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER ` ' FIREPLACE FRYOLATOR _ • FURNACE GENERATOR GRILLE th INFRARED HEATER _LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM!SPACE HEATER `l ROOF TOP UNIT fi TEST UNIT HEATER i.L UNVENTED ROOM HEATER WATER HEATER Underground Gas To Fire Pit V 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY {/ OTHER TYPE INDEMNITY 0 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 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 vAll be In compliance with all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. r-- &VL PLUMBER/GASFITTERNAME: Troy J Gilbert LICENSE# 13573 /� l ATURE COMPANY NAME: Co2stSl Merhanical ADDRESS: 21 L Fruean Ave CITY: S. Yarmouth STATE: MA zip: 02664 FAX: TEL:508-737-8747 CELL: 508-850-6955 EMAIL: Katherine@Coastalphc.com MASTER ' JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# tic V# 4350 c m,iL ADDizesS :