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HomeMy WebLinkAboutBLDG-21-005107 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` 4(=6 CITY YARMOUTH MA DATE March 09,2021 PERMIT# BLDG-21-005107 Ff.F: JOBSITE ADDRESS 22 VINEYARD ST OWNER'S NAME james obrien G OWNER ADDRESS 191 HURON AVE CAMBRIDGE MA 02138-1325 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES E 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/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 E NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP❑ JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbridet gmail.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 C., ` .I _1z` MASSACHUSE S UNIFORM APPLICATION FORA PERM! TO ERFORM GAS FITTING WORK __ r_ s' CITY .` . . (,f�r . Q f/l MA DATE f _ PERMIT# bL DG,1 (-bu 5707 JOBSITE ADDRESS` (J f 11.47 `" +OWNER'S NAME rv.QC�- i GOWNER ADDRESS 7/11 X • toy 171 TEL- 7 TFAX~_- t TYPE OR OCCUPANCY TYPE COMMERCIAL;,) EDUCATIONAL J RESIDENTIAL PRINT CLEARLY NEW:,_1 RENOVATION: REPLACEMENT:_I PLANS SUBMITTED: YES NO li APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _J_ I__-1____J t!._j_1.____J J _____I 1_J _J_._J _BOOSTER _ I ! I I_, _.t—J_1—�•—J_J____1_1_1_J _J CONVERSION BURNER _I—1� 1_j- 1_J I. _� _1 ( J I_J — COOK STOVE . J I __J __I-1 — _—.t—I_1 � —1—J_1_1_ J j _DIRECT VENT HEATER •_ t I__(:_J _J__ .- -I_j (_J J— __i DRYER I—_I J__I' I-J-J —J.___I____J-____J—1• I__I FIREPLACE I_J—J t J• __I____1—J ._ I__._J { I_I_J_J I VP FRYOLATOR .._ 1 J �J—J. ____1 .� 1 1 -__1J_ 1—_J_1 Ilj FURNACE ______1 i1. !-1_.-J I I 1 __1____J `—__I—--_-1_,I—qI GENERATOR I___J 1 J___I 1___.1___J_1___J__I__J_1 GRILLE ; _ t._J.,1 1 _J__J —J.__J _J_J._-._J____I.__J INFRARED HEATER . _____I—J____1____1 I____I, . I_J 1.__J _I J __, I_J I LABORATORY COCKS I i i.—J____I I ,:�`i ____1_-1_J___J___J_J CMAKEUP AIR UNIT ! I-__ __I I I J___.1___J,___J___J,____I_-_ 1_._ _I I___1 toOVEN I ____! 1 I I:____J_____J______I __J I I 1__ I__J i POOL HEATER _I._,__I_____1, 1,___J._I I..____J____..1 I_J�..._....i_J-_._.._1_J_J ROOM!SPACE HEATER �_i 1__ I I I 1_ i I i I I 1___ I_____ 1 ROOF TOP UNIT ___,_! I i 1, 1____J 1 ____1__j 1 J TEST _ i 1 1, J____1 ____.J __1 1 s 1 I UNIT HEATER _.-_.I ; -___a _____J ___I__.._ ; I._._J __I_-1 __I __i___.J I____1 UNVENTED ROOM HEATER Po r-1,rr/7-____J_J I _.._i__ ;,_,_J L 1 I__j _J_J_�1 ___J WATER HEATER eP_1-�-�Ate .._. __.J 1 _1 !__J____J ' ._.__I,-J�J 1 I_._J�J —1 ._OTHER._'_ ...__ ._ - 1 , 1__-_j--� I---J - ! 1 —J-J..I._J.___.! —.1 • - I._ _I __ .- i . - 1 _—J 1 — 1__J_.__1 . I_j _ �1—_J __._I I—J_—1._I_._J_ _I 1 _1___ i I I__-__J I J_ . .1 ___I I_!.._. . I__J__ 1-J I 1 J 1 ___J ___J—i t INSURANCE COVERAGE CI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES kJ NO ID I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY -__Ti BOND Li 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 .- I AGENT J 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 in compliance wit Pertinent provision otithe Massachusetts State Plumbing Code and Ct pter 142 of the General Laws. JA\/\*�,1 }} PLUMBER-GASFITTER NAMEf\ ( a. ( 1� ` I t 1 `( r i 1 LICENSE# SIGNATURE MP J MGF' J JP Vl JGF LPGI J CORPORATION J# (© PARTNERSHIP_-1# 1 LLC J#' ^` COMPANY NAME: ic, P ,. _. .,Pi-- 7I ADDRESS Ci r.,/5 ,. ap r 1 (/`C 1 CITY i j 4 r r-2 z)Li j STA I ZIP(Ll4 73 TEL -_- V7 97 . FAX J CE . . 'EMAIL Cj !t-S- r _ "Lt. A r`, a 03 y'�4--/� . / .1 . 1