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HomeMy WebLinkAboutBLDG-22-006752 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE IMay 23,2022 I PERMIT# BLDG-22-006752 JOBSITE ADDRESS 128 DRIFTWOOD LN OWNER'S NAME COPPINGER SCOTT G OWNER ADDRESS COPPINGER LAURA 128 DRIFTWWOD LN SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ 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/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 0 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 'Paul Riordan LICENSE# 133307 SIGNATURE MP❑MGF❑JP© JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'PAUL V RIORDAN I ADDRESS. 156 Post N Rail Ave, CITY 'Plymouth I STATE MA ZIP 1023601929 I TEL I FAX I I CELL I I EMAIL Iriordanmechanicalno,amail.com • S310N M31/023 NVId #1I V1H d $ :33d 0 D SV S3AN3S NOI1VOIlddV SIHI oN saA S310N NO1103dSNI 1VNId KINO 3Sfl W.1.03cISNI 2I03 3OVd SIHI S310N N01103dSNI Sd0 HOflO I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,' ;_ ?� sa 21— tv7S2 vg-t CITY S`-�1 .;L`r C MA DATE �`L-`-3. PERMIT# y � � `��W (. JOBSITE ADDRESS � 00 �('e- OWNERS NAME C ! FAX OWNER ADDRESS !Same TEL TYPE OR PRINT O CY TYPE COMMERCIAL E!CATIONAL � RESIDENTIAL / CLEARLY :V RENOVATION: REPLACEMENT PLANS SUBMITTED: YES NOS/ NEWw ! APPLIANCES 1 FLOORS- BSM 1 2 j 3 4 5 6 _ 7 ` 8 . 9 1 10 I 11 12 13 14 i BOILER I `5 BOOSTER CONVERSION BURNER r COOK STOVE r- DIRECT VENT HEATER I i I • DRYER FIREPLACE . FRYOLATOR FURNACE J ' GENERATOR I - GRILLE r INFRARED HEATER LABORATORY COCKS'g 1 MAKEUP AIR UNIT I OVEN POOL HEATER ROOM/SPACE HEATER I 1 } ROOF TOP UNIT 1 I TEST UNIT HEATER - UNVENTED ROOM HEATER I WATER HEATER __ OTHER • .I i I 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 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT _.-., 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 Slate Plumbing Code and Chapter 142 of the General Laws. /yam %' PLUMBER-GASFITTER NAME Paul R_iordan LICENSE# 33307 SIGNATURE MP MGF JP ., JGF LPGI CORPORATION i\# l$1214. PARTNERSHIP # LLC #.m_ COMPANY NAME: Riordan Mechanical 'ADDRESS 33 Womponoag Rd. - CITY Plymouth STATE MA ZIP 02360 TEL 508 888 2665 _ _I FAX CELL 774-313-6260 EMAIL riordanmechanical©gmail.com