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HomeMy WebLinkAboutBLDG-22-003306 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE December 10,2021 PERMIT# BLDG-22-003306 iz JOBSITE ADDRESS 149 GREAT WESTERN RD OWNER'S NAME SINKO STEPHEN J G OWNER ADDRESS SINKO CAROL A 525 OAK ST FRANKLIN MA 02038 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL© 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 GENERATOR 1 • GRILLE INFRARED HEATER _ _ LABORATORY COCKS _ MAKEUP AIR UNIT • OVEN POOL HEATER ROOM I 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❑ 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 ILESTER WADE I LICENSE# 4569 SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPG! 0 CORPORATION 0 it PARTNERSHIP ❑#I ILLC❑# COMPANY NAME ILESTER J WADE I ADDRESS. 122 CAPTAIN ISIAHS RD, CITY ICOTUIT I STATE MA ZIP 1026352702 I TEL I FAX I I CELL I 1 EMAIL S310N M3I/132i NVld #IIV Jd $:33d ❑ ❑ 111N2J3d 3H1 SV S3AHRS NOI1VOIlddV SIHl oN Se,11/4 S3J ON NO1103dSNI 1VNld AlNO 3S(127J0103dSNI 39Vd SIH1 S310N N01133dSNI SVD Noma MASS CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK u'rzi ;'-17.7-1A -_____. CITY ; 'iet.ry ve(..; `�t�I� MA DATE !l-a3 -d I 1PEP.MlT 21 - 33a� x, JOBSITE ADDRESS iLi Cl Ortoch )P5krri 1fp/ . OWItIER'S NAME , 549 j 4 c -✓t k-?> T'' OWNER ADDRESS i Sta... ctto o V 2• TEII 1 -7 y-5 3 3-2709 FAX , rpE O OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL in RESIDENTIAL C' .r x::1l.Ri�'�' NEW:FE RENOVATION: El REPLACEIv1ENT• ❑ PLANS SUBMITTED: YES El NO Q---- APPLIANCES 1 FLOORS- BStvi 1 I 2 3 i - 5 61 7 8 9 i0 11 1 12 13 14 BOOSTER�R r 1r-----i; ____T �.._, '! �+ .� y + '� CONVERSION BURNER, __ �_ __..__r t t. f� ;� �_ii ; __' ,'� �.Y7�_� i COOK STOVE ;� i f ,t �+ ►, ( I' 41 ._.-a__.._....;.._. --,.--, DIRECT VENT HEATER I!._.__. 1�1---=-=^1-- t! .1 .�.... ! h 'f ;! i rr�cwr...ti.r.+ � r.�-..I..�.r.-...r�✓.r 1. —.+.4..yui�ci..—.�rn•ai� DRYER (! ...__ 1 '�� 4; --#�-,i_ .--..i.... _ �� FIREPLACE ;; ri (� :� -'sf � .I I: FRYOLATOR ! ..t. _.'S_. . _ j� . „ .1.„ :, - . ! ._. `' _� - FURNACE I _ , I.- - f- .,r (- i �� =1 GENERATOR _ - ._-1_r' t . _ .{ h(..._ (; t_ ._..__. ----- -=-=--.-u - -+s -- I ._ GRILLE IL Ir=---i `.=��---___.�`t----+ in 7 1�-T ;; '— I INFRARED HEATER 1---) '; 'L i ---17-1L j :f _. 'i— -,�. LABORATORY COCKS '`r --I'i i- r-_....__D ' ' r ,T_ _Y'i. MAKEUP AIR, UNIT IF.. 11 ii _ - l��t _;.� . � f_ I _ t . . . _, POOL HEATER ..L li _I =---7----=,1 j I1-- ,;- -- 1 Li ROOM / SPACE HEATER 1 '1 it _. - fi i i i Ii _ ' ...__ ROOF TOP UNIT 1 IL . _- iI i? 1 r—1 E..-1 .: __. 1-1 . . _ :! ( TEST a n�_y.}jIc..�,..�ai.,. .. �1 ._._ 11 ,__,., _ i�.., ' ... UNIT HEATER I i 'l - - .._... .r.. `i i1.�.....J:i�..__.._ ___.__. r.,�-- UNVENTED ROOM HEATER L — '1,,---_ _ '' .' ; _ _ � -('- u j ._ i WATER HEATER L.. . It .__ iT i!_,,._ i _ fit_.. _._..__,_.._. OTHER I 5L :, • �L._. _ ., _ :: Fi1..,;..:,. i _:,:i:.- -i--- (,.,.,_._-. �.....1r..._.....3'.� r at .�' _r - ------ •........T'- 4i._:_.,I I. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements oi• iv1GL. Ch. i42 YES Q 110 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BO„ BELOW LIABILITY INSURANCE POLICY ✓� OTHER TYPE INDEMNIT► !Li BOND n OWNERS 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 AGENT ED 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 time best of my knowledge and that all plumbing work and insalfations performed under the permit issued for this application will be in co pliance with all Pe :'nent pJovislon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws ``:��..' J's J VY PLUMBER-GASFITTER NAME �I ee.,,.....- 54c. v.)et_et e., ' LICENSE # +5toci SIGNATURE MP MGF (-. ' JP r-I JGF fl LPGI ❑ CORPORATION L# I PARTNERSHIP EP' LLC �n COMPANY NAME:�e ('( z•b .•l.' poXpRESS 23 gttiy 4c cv, R.4.1 • CrCY MAMA, pe STATE ! MA %JP Oat; l ' IELj 50ss—Y71- 3- FAX 1 10ELL1 - 5V EMAIL tlti-r �, CC 4' p le.,,t,N•Y 3 4 car, vv