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HomeMy WebLinkAboutBLDG-22-006986 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE 'June 02,2022 I PERMIT# BLDG-22-006986 JOBSITE ADDRESS 46 MERRYMOUNT RD OWNER'S NAME OSHEA RONALD R G OWNER ADDRESS OSHFA.ANTONIETTA 285 MILTON ST DEDHAM MA 02026 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL© PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND El 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑#I Inc❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanyna.amail.com S310N M3IA32i Ndld #.IINH13d $:33d ❑ ❑ 1IW213d 3H1 SV S3M3S NOI1V3Ilddb SIH1 oN saA S310N NOI103dSNI lt/NI3 KINO 3Sfl 2I0103dSNI 2iO3 JOVd SIHI S310N NOI103dSNI SV9 HJf10Zl GO., cc' _. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Y I.nukl_... _:. CITY _ + s$_ Vi9.1,,i14.O t9 t.._._.___.. i MA DATE ,.7Aal PERMIT# ZZ'' 6`l S'6, JOBSITE ADDRESS G _._. 2 pr9�r r OWNER'S NAME I p gV s.U_ 1O t7 e LC OWNER ADDRESS ' ' TELL/247 A I. --] TYPE OROCCUPANCY TYPE COMMERCIAL© EDUCATIONAL 0 RESIDENTIAL k4 CLEARLY NEW:a RENOVATION:Li REPLACEMENT:L PLANS SUBMITTED: YES[„.J NO[! APPLIANCES-1 FLOORS--t BSM i 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ; .... -. _, - _ ._ ��1 BOOSTER y CONVERSION BURNER = _ COOK STOVE - C =14� .4__ ( - _--e . . z -'I _ 1_ DIRECT VENT €��- �I- +r [< h € HEATER r DRYER _.___,. .w 1- t-J- ,�� _. ri„5 t 4: i t L ...__ L ___- FIREPLACE FRYOLATOR ,,- a € FURNACE Spar .'I i. J- �_ ,_„f( i ;; 1i 1 F_�I GENERATOR = - t GRILLE , . , r .�x INFRARED HEATER �.. .._. P1 _:..-��,._.�� ,F t :cam, 1 S: ...5. �. _ LABORATORY COCKS _ - MAKEUP AIR UNIT i N OVEN r r ( t .. ' r f tr. II�, mtc t, .:ice �iK - __I __ POOL HEATER -- , ,_ ��._ ( �_ 'P €. � �� �.� i `� ROOM!SPACE HEATER ��-I (I i ...177 i i I(� i( ROOF TOP UNIT ...,...: , ...., , f i" _ g r � € i[ TEST _, :�I, �T.._. �1 _, €- € I D r,-- z , UNIT HEATER € I , i UNVENTED ROOM HEATER _. .. I i1 r ( L_ WATER HEATER - , -�:, ...E,__ 1 ,,LjI J._ F , ,[. 1( .1 _ OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL,Ch.142 YES IA NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' OTHER TYPE INDEMNITY {. _.j BOND [-1 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 L AGENT Li SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicali are tru'and curs o the st of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will e In com tanc with Pertin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASF€TTER NAME itike'1 ty2 i ro LICENSE# tom__ SIGNATURE ' -.____J MP B MGF Li JP 0 JGF Li LPGI[J CORPORATION # 3)3y e J PARTNERSHIP Li#,__ _,_ 71 LLC f i;#[_ ,-_^1 COMPANY NAME: ,4/,,a 4< ,014 t G /LPe. . _ ADDRESS ............ CITY L .S'o,.-. a' t 5 STATE .t,/9 ZIP O2 L&C TEL t9 _'3�' 3 3`3 t FAX fV1.. �, � EMAIL 8)CELL / . - �/lfc�.. . sy�l !u i ir,,,9/.4� C Oct 1