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Home My WebLink AboutBLDG-23-000044 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK N.,.-,.. se CITY YARMOUTH MA DATE July 05,2022 PERMIT# BLDG-23-000044 `-SF' JOBSITE ADDRESS 54&56 MERCURY DR OWNER'S NAME KWOK GORDON Y G OWNER ADDRESS KWOK CHENG Al 19 DEERFIELD RD SHARON MA 02067 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 ❑ 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 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride(a gmail.com S310N M]IA321 NVId #11Wa3d $:33d ❑ ❑ 1.11,1H3d 3H1 SV S3A2,13S NOIiVOIlddV SIHI oN saA S310N N01103dSNI IVNId AINO 3Sf1 d0103dSNI 210d 3OVd SIH1 S310N N01103dSNI SVO H9f10N �.., MAS ACHtJ ETTS UNIFORM APPLICATION FORA PE MET TO PERFORM GAS FITTING WORK _-�.- ( 11).7_,{i_.t7 ` p N CITY 5i\I a �M 0 O MA DATE, 2� '4iy ,, PERMIT # 2-3ov"IL JOBSITE ADDRESS G fr5.-b f r� r (001't OWNER'S NAME OWNERG ADDRESS ��, � _.. ? ,0,e.�/ L� 17C-5 �� TELZe FAX j TYPE OR S - �� ✓�,¢ }PRINT OCCUPANCY TYPE COMMERCIAL il EDUCATIONAL ❑ RESIDENTIAL [Y CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: Me- '`�f PLANS SUBMITTED: YES APPLIANCES .1 FLOORS-+ BS1v1 1 ? BOILER J 5 F 7 ° y 11 I-I 12 13 1 BOOSTER f CONVERSION BURNER I _ COOK STOVE -H T DIRECT VENT HEATER r DRYER FIREPLACE ______T FRYOLATOR _____, FURNACE t7EIVIFIX --- GENERATOR GRILLE �.... __..�_ _..�.._. INFRARED HEATER ---- JUL � LABORATORY COCKS MAKEUP AIR UNIT OVEN BJILUTNC., CAE }ARTM-ENT gy - - POOL HEATER ROOM ! SPACE HEATER ROOF TOP UNIT ---_ , TEST _ . , UNIT HEATER _ UN'JENTED ROOM HEATER ( -----I WATER HEATER OTHER I I 1 I INSURANCE COVERAGE I I have a current liability insurance policy or its substantial equivalent which meets the requirements of EIIIGL. Ch. 142 YES, 1 � NO --� I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY W OTHER TYPE INDEMNITY ❑ BOND 111 • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b CE Massachusetts General Laws, and that mysignature on this permit application waives this requirement. y tapter 1��, of the SIGNATURE OF OWNER ORr^ CHECK ONE ONLY: OWNER E AGENT AGENT ❑ '.1` I hereby certify that all of the details and information I have submitted or entered and installations performed under the permit issued for this application regarding this and that all plu cbing worl� gwilll, otion are true and accurate to the best of my knowledgetts State Plumbing Code and Chapter 142 of the General L w , be in compliance with all Pertinent provision of the Massachuse Ui 9�nPLUMBER-GASFITTER, NAME1\4 f `� / I �-� C I LICENSE # MP ❑ MGF ❑ AJGFE LP ,I SIGNATU❑ .CORPORATION ❑ F PARTNERSHIP ❑ # LLBCUMI�ANI'' I�IAItIIC 7 -4 ADDRESS �r n CITY ` S STATE 46A. ZIP 22____LLL. TEL FAX CELL ' EMAIL ROUGH GAS IN�PE€�TI�r�I O TES THIS PAGE FOR INSPECTOR USE ONLY k'INAL INSPECTION NOTES Yes NQ THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES • •