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HomeMy WebLinkAboutBLDG-22-006825 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 24,2022 J PERMIT# BLDG-22-006825 LL.VI JOBSITE ADDRESS 210 SOUTH ST OWNER'S NAME Christine Mandara G OWNER ADDRESS 01104 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL©' PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF T0P 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 ILESTER WADE I LICENSE# 14569 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG! ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ILESTER J WADE I ADDRESS. 122 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY ICOTUIT I STATE MA ZIP I026352702 I TEL I FAX 1 I CELL 1 I EMAIL IinfoW.ccipgenerators.com S3lON M3IA321 Nbld #.IIN2:13d $ :33d ❑ ❑ 111,183d 3Hl SV S3A213S NOLLV3llddV SIHI oN seA S310N NOI103dSNI lYNId KINO 3Sf1 8O1O3dSNI 2JOd 39Vd SIHl S31ON NO1103dSNI SV0 H9l0N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I ct r E t t+ MA •DATE J a PERMIT# Z JOBSITE ADDRESS a•I,0 SCi)-{-G) St ; OWNER'S NAME C c-i` 5 MLC c 2C GOWNER ADDRESS S!Ct- ( -)O TEL 1 1 " 5 Y- 13 3 7FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL rgi PRLNIT CLEARLY 'NEW:I1 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO[l APPLIANCES 1 FLOORS-4 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 I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER . OTHER l INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ® NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY {] 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. • _ CHECK ONE ONLY: OWNER ❑ AGENT [j SIGNATURE OF OWNER OR AGENT I hereby certify that of the details and information t have submitted or entered regarding this application are true and accurate to the best of y knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance all P t on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C � PLUMBER-GASFITTER NAME Lt! +€-r IA)a Et- LICENSE# 4 5(0q SI RE MP❑ MGF® JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME Ate C_itz el T1442 greet d?. �ti-¢ f�ea.i ��_ ADDRESS BeD .;et t In get. CITY l\k .S -e ' STATE ILA ZIP ( -tr' TEL 50�-4--D1 FAX 6,.)0A CELL 5O%-15O--S.S _ EMAIL +0 S, a:r=0,04