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HomeMy WebLinkAboutBLDG-23-000642 ,fie MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK g CITY YARMOUTH MA DATE 'August 08,2022 'PERMIT# BLDG-23-000642 11_FY JOBSITE ADDRESS 161 SUFFOLK AVE I OWNER'S NAME I,SPLAINE JUDITH A G OWNER ADDRESS SPLAINE JAMES R 3 REDGATE DRIVE MEDWAY MA 02053 TEL' TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:0 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 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 ❑ NO 0 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-GASFITTFR NAME Andrew Leighton LICENSE# 16130 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IANDREW R LEIGHTON 'ADDRESS. 120 Brewster Rd, CITY 'W Yarmouth I STATE MA ZIP 026735706 TEL ' FAX CELL EMAIL IhalloilcompanvD4mail.com S310N M3IA3H NYld # LR 3d $:33d ❑ ❑ iI012:13d 3H1 SV S3a1 S NOI1V lddV SIHl oN seA S310N N01103dSNI 1VNId AlN0 3Sf1 dO103dSNI 210d 3OVd SIH1 S310N NOI103dSNI Sd0 HJl0d _ 4 (00 4 ••'... ..'------ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '-0.--x Yavnio CITY St _ MA DATE' o: o`�v`� J PERMIT # Z-3 — '3Lt Z • JOBSITE ADDRESS. (DJ . 5tij 01 1 — ____._____-___-.__.. , G -_ V �. ._ OWNER'S NAME OWNER ADDRESS : If " T^_ TEq O -,3ci r?,ST FR?( ---_- -_ TYPE OR OCCUPANCY TYPE COMMERCIALf EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:ii<RENOVATION: Li REPLACEMENT: ri PLANS SUBMITTED: YES[I NO3 APPLIANCES 1 FLOORS-4 $SM t 2 3 - 4 5 6 7 8 9 TO 11 12 13 14 BOILER '�'• I'" 1 � ``�!{' - ,r - BOOSTER _ ( �� t,..{ . . ..w- _ . .w.. r_..�.r �,z_:..... �. F___ ii 1 CONVERSION BURNER i y , . _- � .�.! -.,. .:L,=s1L__ :±•. z_. .�-_ - -ems, :_:s"_,��,�`�fl7. -J -�_L.... �.. f : _ Ire.:-. 'i COOK STOVE =— - 1 __ E--� - --- — _�, DIRECT VENT HEATER - ,._.� f= 1 .,, --,. if �T„�.:... I �t.,........._ ......_.....__ ..,,,..„.. ,.., ............_....... ... ,;.. . - FIREPLACE ,.., ,....... ..,..t.__, t....,,..,..., I DRYER fs I_ _ ._-..._..,+.- _..+ 7• —_...,. ,/ S' .a_w,X s ..,._ L e.. : li .•k_ ._ - kI rRYoLATOR �`- i---- - t ,. . . . _,, t ,.....__73 FURNACE � -_ r _ _ _ _ _ T GENERATOR : _ ----7 -----.-- . if ii GRILLE �;; —f • I 1 Fps _Y.�t ,��. +._..v_-_ .j „��•j' �L . •/M.. , -.�n- - ..h w '•�rriY i INFRARED HEATER r---. _ i . I< j I LABORATORY COCKS l 1, _ MAKEUP AIR UNIT F,_ . — _ _ ___:_- t .. . ;:„w-_� a:_...-_••_ ,a _ OVEN . (c' - - TIL _I t--: -- t tl 71 POOL HEATER '�n._ _0_�._..._.,; _._._ z.� ! t` `V_ -/._ }.vY•-r_. ..—'�f' .. ..[_ �-h...a:•-. M- _. �..A.R4.x�-1 +.1_... ._a S• _L ROOM/ SPACE HEATER ! r____-_� =�.f � I ..�.� r : �_._ �v.9-. Scar_. .___,.t.:„I, >...:Y...;..`lhew/.-`.0 _ ... v..._..„_ c:Jh:ri` I_r._+�....'LI _�D_a._ .....--�- .-r.4,6,..� •• - ROOF TOP UNIT — ,.w - TEST it - t �, UNIT HEATER 1 ___ i �, • �' Tirt.�. . ' — - - -fir � — --- UNVENTED ROOM HEATER �._:: �( I�� 1; _. ► vu. L.. _ _. _... '�a.y . .- .z_ F �. _ _ . WATER HEATER < i' - Es 1: - OTHER _ } }#. t }c ;�_ �` _. . _ • ._....... _ - - _.c - ••.Lary_ ..r= .....-.... -,...-�- ....r... .$+w:-_ _ •r,.e.+r.- -.ra- , , ---- 16 ,;..a....1,....:tip`.c_:.r4,a.7.4F�'.c,r_•wr... v..-.,... _____IF___:__-_- .a.t,averw:.. .-.- ... .�..._>, ..,„� ..�,,��,..r-c•-y-„�s�.,.,•�.. "-Q�-r._ .r+r.- {r..=ate.. ..c...>:.r. G.� .• • -s-r-T�-•r�;.R..,--. f..fr .. 1.:..:..c..u..1 r..�.-4-----1 I �, I INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES eflo LI • I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY n BOND _r I 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 Li AGENT 1_1 _ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this applicali are truand cura o the st of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will a in comp;anc with Pectin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i PLUMBER-GASFITTER NAME�, yA efr. �. c.e, 6g?1 i LICENSE # t i r SIGNATURE MP !' MGF U JP ri JGF LI LPG! [J CORPORATION [` # 3') y e PARTNERSHIP L_.._J# _ LLC Li# __ -_ COMPANY NAME: ._ D!c C 6 - zT fC- ADDRESS _ '`3.z. J3 .. j ....1.�. .._. ..p _ i'i6' .. ..yL--�... ._�. v -.au-ten✓.emu-__ +w.+w_•i+ss CITY Spy - 1 I J STATE it-1,3 ZIPI c & TEL C - ~ - 3 3-3 FAX Wif:_j,4, 0‘ CELL JEMAIL Z Ef . ___ , er.-. /9i L� %'_ •__. .„,.,.._ ___.. ... __ ._