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HomeMy WebLinkAboutBLDG-22-004227 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kg, CITY YARMOUTH MA DATE (January 28,2022 'PERMIT# BLDG-22-004227 JOBSITE ADDRESS 63 ABELLS RD OWNER'S NAME ISYKI LLC G OWNER ADDRESS 63 ABELLS RD SOUTH YARMOUTH MA 02664 TEL' TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES❑ 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 1 POOL HEATER ROOM I 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 ❑ 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 ❑ 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 ryan ledin LICENSE# 34014 SIGNATURE MP❑MGF❑JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: LEDIN PLUMBING ADDRESS. [harvest lane, CITY Berkley STATE 'MA 'ZIP 02779 TEL FAX CELL EMAIL LEDIN617(UYAHOO.COM SALON M31A32I Ndld #iJI I3d $ :33d ❑ 1IW213d 3H1 SV S3A213S NOI1Y3Ilddd SIHI ON seA SaLON N01103dSNI lYNId KINO 3Sfl 210103dSNI 210d 30Vd SIHl SALON NOI103dSNI SVO HO 102! =:�=�r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING �.:'����'.y,N CITY �r w► 04� MA i I Z�( Z Z,_.. • DATE PERMIT �; 22 Z -- cl 2 Z-? JOBSITE ADDRESS 43 A L-tt5 14. OWNER'S NAME ,_sk ,___ G OWNER ADDRESS 60 I �c).,, em 5 ii,ortAcwne EL 78 i -8 31_ Z MI FAX ,^X TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL (J EDUCATIONAL f RESIDENTIAL ar NEW: E REND\/ATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NoD APPLIANCES -1 FLOORS--+ BSlui 1 2 3 1 5 6 BOILER 7 8 9 10 11 12 I; 1_ BOOSTER CONVERSION BURNER —_____i COOK STOVE -- DIRECT VENT HEATER . DRYER, _ 1 J FIREPLACE �— . FRYOLATOR ' ,__________=_____j. FURNACE # ----, GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS i MAKEUP AIR UNIT -` OVEN I POOL HEATER i ROOM ; SPACE HEATER , ROOF TOP UNIT TEST , . ---, . . NIT HEATER UNVENTED ROOM HEATER WATER H EATE R OTHER I I INSURANCE COVERAGE I I I have a current b U insurance policy or its substantial equivalent which meets the requirements of IUIGL. Ch. 142 YES ❑ NO 1 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ElOTHER TYPE INDEMNITY [1] BOND ` OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required byChapter 1 2 Massachusetts Genera! Laws, and that mysignature on this permit application waives this requirement. `t� of the 9w.r CHECK ONE ONLY: OWNER SIGNAT .E OF OWNER OP, AGENT AGENT ❑ ` t` I hereby certify that all of the details and information I have submitted or entered regarding this application are ru and that all plumbing work and installations performed under the permit issued for this application will be in com li eand with all P en v curve to the best ovision oftl�e `I PLUMBER-GASFITTER NAME LICENSE # 3A0 0\ SIGNATURE MP ❑ MGF ❑ JP Ei JGF ❑ LPGI ❑ CORPORATI ON ❑ # PARTNERSHIP ❑ # LLC 0 # COMPANY NAME I. e b:A 9kuipAist.ny ADDRESS 8u, CITY c2)e•CYAGe ' STATE ZIP o 2,1 7 TEL FAX CELL 774-365 6000 EMAIL Led ti•611 os, ^ CLO ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES 2,-4 //27/z z- Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES