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HomeMy WebLinkAboutBLDG-22-004466 — MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ', V. CITY ,YARMOUTH MA DATE February 10,2022 PERMIT# BLDG 22-004466 11 JOBSITE ADDRESS 32 DANAS PATH OWNER'S NAME ZACHER JOSEPH A G OWNER ADDRESS ZACHER LAURA A 2817 STROHL RD ALLENTOWN PA 18100 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL En 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 'ILL -- BOILER 1 — BOOSTER — CONVERSION BURNER i _ COOK STOVE 1 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 ❑ 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 Troy Gilbert LICENSE# 25383 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑#1 COMPANY NAME: TROY J GILBERT ADDRESS. 39 STATION ST, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX I (CELL EMAIL • S310N M31A32i NVId #1M1/183d $:33d ❑ ❑ lIV' 3d 3H1 SV SSA8SS NOI1V0IlddV SIHI oN seA S310N N01133dSNI 1VNId .LINO 3Sfl 210103dSNI dOd 30Vd SIHl S310N NOI133dSNI SVO HOf1021 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK A y CITY Yarmouth MA DATE 02/07/2022 PERMIT # Z'l- `1 i. , JOBSITE ADDRESS 32 Danas Path IOWNER'S NAME Joe Zacher .1 GOWNER ADDRESS 2817 Stroh! Rd Allentown PA 18100 TEL 610-554-0973 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: i REPLACEMENT: PLANS SUBMITTED: YES® NO v. APPLIANCES Z- FLOORS-► BSM 1 2 3 4 5 6 7 8 9 10 11 12 11 14 BOILER IMO inn IiiiiIMMIIIIIIII MI IIIIIIMIIIIIIIIMMM— - - BOOSTER mummimmiguimmormi— mum-iimujim CONVERSION BURNER gimmimmiiiiiiimi ___ imam al -IMMO COOK STOVE MOMIIIIIIIIIIIIIIMM .___ MOM DIRECT VENT HEATER INIII NM MI —1 FIREPLACE ll= MIMI • • •- =1111151MMIIIIIII— Li_ ral lipl Mill Mill. IIIIIII 111111MilirMinindlit ---1.E liE . . OVEN M ll— P POOL HEATER 0 mi m � ROOM / SPACE HEATER 1- II111111111M1111111 NMI MI=1111 NS ROOF TOP UNIT MI W -1M11111111 _ 11111111MI TEST I 1 IMIUM Mill M11111111111111 I UNIT HEATER UNVENTED ROOM HEATER ® II WATER HEATER I i _ imam OTHER [ v_.._ -AllM1111111111111111111 Rs m Eillitm 1111111111Illiiii1111111111111111111111111C Nil , I M ... ...... �! 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 i . OTHER TYPE INDEMNITY 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. 6`6-0. CHECK ONE ONLY: OWNER [_.. y AGENT d SIGN URE 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. �2.d /J� _ PLUMBER-GASFITTER NAME Troy Gilbert LICENSE # 25383 1 V SIGNATURE MP MGF JP Q JGF 0 LPGI CORPORATION Q# 4350 ~ PARTNERSHIP❑# I LLC # I COMPANY NAME: Coastal Mechanical ADDRESS 21 L Fruean Ave ......................i CITY [South Yarmouth STATE MA I IZIP 02664 TEL [1,08-737-8,747 I FAX[ 1 CELLI 508-850-6955 Kat iEMAIL herine@coastalphc.com _I