HomeMy WebLinkAboutBLDG-23-000032 ,� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
�' CITY YARMOUTH MA DATE July 05,2022 PERMIT# BLDG-23-000032
JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 7G OWNERS NAME Cronin
G OWNER ADDRESS MA TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El
PRINT
CLEARLY NEW: ❑ 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 1
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
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 El NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER OF INDEMNITY El 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 Charles Stockdale LICENSE# 24526 SIGNATURE
MP 0 MGF❑JP El JGF El LPG! 0 CORPORATION❑# PARTNERSHIP 0# LLC 0#
COMPANY NAME: CHARLES L STOCKDALE ADDRESS. 1256 MAYFAIR RD,256 MAYFAIR RD
CITY SOUTH DENNIS STATE MA ZIP 026602803 TEL I I
_FAX CELL EMAIL IclsplumbI gmail.com
S310N M31A32J NYld
#.IV 3d $:33d
El 111,12f3d 3H1 S`d S3A2i3S NOIlV011ddb SIHl
oN saA
S31ON NO1103dSNI l`dNId NINO 3Sl 2J0103dSNI 2J03 3OVd SIH1 S310N NOI103dSNI SVO HOflO i
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
l
7_iFV.-
till CITY Yarmouth MA DATE 6/27/2022 PERMIT#
Z 3 -- 00-S.L
JOBSITE ADDRESS 300 Buck Island Rd. Halcyon 7G OWNER'S NAME Cronin
GOWNER ADDRESS same TEL 774-487-8724 FAX
TYPE
PRINTR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER ,
CONVERSION BURNER
COOK STOVE 1
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM 1 SPACE HEATER
ROOF TOP UNIT .
TEST .
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES e 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
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachuse eneral Laws,and that my signature on this permit application waives this requirement.
V - CHECK ONE ONLY: OWNER AGENT
IGNA URE F 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 Charles Stockdale LICENSE# 24526 SIGNATURE
MP MGF JP i JGF LPGI CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME: Charles Stockdale ADDRESS 256 Mayfair Rd.
CITY S.Dennis STATE MA ZIP 02660 TEL 508-398-2843
FAX CELL 774-208-1613 EMAIL clsplumb@gmail.com