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HomeMy WebLinkAboutBLDG-23-004984 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ki`•p CITY YARMOUTH MA DATE March 10,2023 PERMIT# BLDG-23-004984 JOBSITE ADDRESS 332 STATION AVE OWNER'S NAME [VERONICA WILLIAMS G OWNER ADDRESS DARREN GRAY 332 STATION AVE SOUTH YARMOUTH MA 026640000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:12 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 1 GENERATOR GRILLE 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 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 John Quinlan 'LICENSE# 111932 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'JOHN W QUINLAN I ADDRESS. 1118 ELM ST. CITY 'E BRIDGEWTR 'STATE MA ZIP 1023331418 I TEL FAX I I CELL' 1 EMAIL IinspectionsWcottiiohnson.com 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 t. MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK :, �° ll ,•g Uc z3-coy97 y kf CITY: 74r1AQIT�� MA. DATE: .3/c./.2"3 PERMIT# - II I JOBSITE ADDRESS: 33 5A1 t't:1�Y"1 A V2 OWNER'S NAME: Le(0tn icra ) c 1 L L 1 aM-.5 GOWNER ADDRESS: 3 � *ccr cal AV e TEL: 51 -1/11/t .•) 33 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL S7( v PRINT ____ CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:i PLANS SUBMITTED: YES❑ NO APPLIANCES-1 FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Cr BOILER BOOSTER U CONVERSION BURNER n` COOK STOVE i-•-• DIRECT VENT HEATER ." DRYER .� FIREPLACE CO FRYOLATOR FURNACE V , GENERATOR GRILLE t INFRARED HEATER j LABORATORY COCK `+1 MAKEUP AIR UNIT OVEN 1 POOL HEATER ROOM 1 SPACE HEATER --.1 ROOF TOP UNIT fi TEST UNIT HEATER i,V UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E(NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:lam aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass husetts/General Laws,and t my signature on this permit application waives this requirement. of"(e) C� CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information t 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. /"c PLUMBESFIERAME: i n dl �tv t � LICENSE# //.3� tC SIGNATUE COMPANY NAME: C.C111- JCh i1,5a,. N W ADDRESS: zO tjauer(j. AI" T CITY: lac 111CV2 STATE Mil ZIP: C,a7O FAX: 774-57)1-3Ic?I TEL: 1 J 7 ii.3(..;(8 CELL: EMAIL: r S 'G Cr 'N MASTER EffJOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0# PARTNRSgP pig 1 # yoo C in nit-- AD e SS ' MAR 10 2023 - Ligrt?7, 4-?,,AM E N T �� 60 gy.--