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HomeMy WebLinkAboutBLDG-22-007227 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 14,2022 PERMIT# BLDG-22-007227 JOBSITE ADDRESS 92 ELDRIDGE RD OWNER'S NAME LOONEY DIANE G OWNER ADDRESS C/O MARION E GREER 92 ELDRIDGE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO ❑ 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 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 El 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 Jared Wilber LICENSE# 15219 SIGNATURE MP© MGF El JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# Lc El# COMPANY NAME: JARED WILBER ADDRESS. 474 WINSLOW GRAY RD, CITY S YARMOUTH STATE MA ZIP 026644317 TEL FAX CELL EMAIL larbernie123(a,gmail.com S310N M31A321 NVld #11W2l3d $ 33d ❑ ❑ .I1N2i3d 3H1 SV S3A2J]S NOI1VOIlddV SIHI ON SaA S310N N01103dSNI 1VNId A1N0 3Sfl 210103dSNI aOd 30Vd SIR! S310N N01103dSNI SVO HJl02! • H `14 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �--� s 'Iro, N ��-?i tis� CITY V z4 ^4›.( � Lt_li> MA DATE L " I P ^l" 2 2 PERMIT# 7 t - z z 7 JOBSITE ADDRESS °,72.. _ 7G 1 rr OWNER'S NAME [;---fir-e 4e Y OWNER ADDRESS 4' c�4h� 1 C� (1 YEI- FA?; TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ FE SIDEJTIALPRINF CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ 1 i APPLIANCES-1 lul FLOORS-4 6� t ? 3 4 5 fi 7 8i BOILER 5 1il t'I 12 _ 14 BOOSTER — I CONVERSION BURNER COOK STOVE —� - DIRECT VENT HEATER —J— DRYER FIREPLACE _i FRYOLATOR FURNACE GENERATOR. --- GRILLE INFRARED HEATER LABORATORY COCKS —� MAKEUP AIR UNIT R . E IN [ D - -� OVEN POOL HEATER —___i , 4 �ZZ ROOM I SPACE HEATER14 ROOF TOP UNIT TEST . . � UNIT HEATER INVENTED ROOM HEATER WATER HEA ER OTHER _ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ ND ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Pi. OTHER TYPE INDEMNITY ❑ BOND ❑ I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the CMassachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OP, ENT Ar, CHECK ONE ONLY: OWNER ❑ 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 compile a wit all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Q.) PLUMBER-GASFITTER NAME j etAt-e- (I. Vt) 1 19 c. LICENSE# /SU z07'L ./PPLt SIGGNAATURES ( TURE '-2— MP MGF❑ JP ❑ JGF❑ LPGI ❑ CORPORATION ## PARTNERSHIP❑#r LLC❑# • COMPANY NAME 3 e Ci-J i I uvri 6 tv-) ADDRESS t'1 T L/ 'V' t1 1n5161.d &rct r CITY ✓. , Vzzy kio4 141 STATE Nei, ZIP G 26 G 4 TEL 373 FAX CELL SO ttyf e EMAIL ROUGH GA 1r ____ TI ICI 'E, THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes NO THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT tt PLAN REVIEW NOTES