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Home My WebLink AboutBLDG-22-003591 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — CITY YARMOUTH MA DATE December 28,202'PERMIT# BLDG-22-003591 JOBSITE ADDRESS 214 KATES PATH VILLAGE OWNER'S NAME Suzanne Scallion G OWNER ADDRESS 214 KATES PATH YARMOUTH PORT MA 02675-1451 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 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 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 hereby certify that at 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 Redirect provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Thomas Coughlan LICENSE# 8529 SIGNATURE MP❑MGF❑JP 0 JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, CITY WALPOLE STATE MA ZIP 020812240 TEL FAX CELL EMAIL - S31ON M3IAR1 NV1d #±IWbJ d $ :33d ❑ ❑ JIWa3d 3H1 SV S3/183S NOLLV011ddV SIHJ ON sal\ S310N NOI103dSNI 1YNIJ A1NO 3Sfl 2iO103dSNI ZIOd 9OVd SIHL S31ON N01103dSNl SV9 HOf1Oel �` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK l i CITY / A/yi 0 (Zits.p o I t ... I MA DATE /).-/6 - il PERMIT# Z.Z. - 3 51 JOBSITE ADDRESS 7' k&fit 63 I OWNER'S NAME �iA Z NA-= J i,A L1 :a I —_____ --� --_. _ ---1a . _ -- G OWNER ADDRESS . R E C-E ITN/-E-Ct_ 1F' .____ I TYPE OR OCCUPANCY TYPE COMMERCIAL:] ECUC.,ITIONAL_- EoI RDENTIAL`, CLEARLY NEW:.] RENOVATION:_J REPLACEMENT:A. DEC 17 2021 PLANS SUBMITTED: YES _ NOW APPLIANCES 1 FLOORS-, BSM 1 2 3 4 ._ B Il f11�IG DE�PA.RTQVIEN'10 10 11 12 13 14 BOILER __J I I J ' -1 _ a� - I I _ J__J—J-_ —J J BOOSTER —J 1 I !— ____J—I—J____1 _I—J—J—I—J CONVERSION BURNER I I __I I_J I I I I___I _J I_1 —J COOK STOVE 1 I I____1 1.___1_ __J__I J_J__I 1_J DIRECT VENT HEATER I___J-_____I __I._____I ___i __I__J _1_j I_J J _J__I DRYER I—J —1—J_1.!.—J 1 _ _I I I__I (—J FIREPLACE i—J . _J I___ J I____II I_J I 1 I_. I.—J I ____I FRYOLATOR I I _ —I I__I __!_J FURNACE I71.GENERATOR I i 1 i i I I_ I GRILLE __i__J _I J I i_._._J_._J _ '—._I I __-) .__J _____J-_--J INFRARED HEATER y_J_J __J I I _1 j _I I 1 _ J__I__J —J LABORATORY COCKS __ __.I l I._.__i.____I- !___.._J__-___J----_J- I 1 _ 1 1 I api, MAKEUP AIR UNIT ._I_-_J I_J___1 ___J 1 __I It OVEN I .-._1 ---. ___._=! -__ _I ______J_.__.I___.1_...i -___!__ _! _. i��i I __Ii POOL HEATER _J I 1 1_ 1._._.I I__I__..J I_.—I_._-1_J_J ROOM/SPACE HEATER _____I !.___._I I l _. 1_�__,_ I _ I -_ _I__1 __---J -..,.I I ROOF TOP UNIT ___I I ____I _._I __1 Y -I ! .1 1 _ J 1 I TEST 't- l i.____.1 ___I I _ I 1 UNIT HEATER ! _ -_ • `J r UNVENTED ROOM HEATER __l ___II ___ -__J __J _ I___1. I___._J __i ,J WATER HEATER II ; I I I 1 ._I !. 1__I OTHER � � I 1 _ ._ 1 ____I I 1___-___I ! ! 1 . J_._.. I I I• 1 . I 1 - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �I J NO J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY') /.J 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. 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 be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �,7 /2 (1 n T6'Lc*fh1a1'i I d d v, PLUMBER-GASFITTER NAME. i�fb r;i AS' C. -�.P1 AJ I LICENSE# �k'S 7 /1/ SIGNATU MP MGF ._J JP JGF,J LPG' _J CORPORATION #_ / 7 I PARTNERSHIP_# I LLC _I# 1 COMPANY NAME: `-G l�t7r7-1N -i'-COOr✓i,t)C-tADDRESS L t` (n aC.,i 9$ ��L y ff - - --_-_-__-----_- --.....---------- CITY fIkt✓,0c I STATE 4t1k1 ZIP ^L)X )?-- ITEL 471 -73 7`c),,o 1. FAX `:J I CELL 1 EMAIL` /)i M / 4L/ 6 MA tz-• (_()4/�. I Ste. -7• e-8)//3 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 • r• • yy ` I