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Home My WebLink AboutBLDG-23-000044 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK a=� CITY YARMOUTH MA DATE July 05,2022 PERMIT# BLDG-23-000044 I.f_ JOBSITE ADDRESS 54 856 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:0 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❑ 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.mcbridena.gmail.com S310N M31A321 NVId #1111213d $ 33d ❑ ❑ 11W213d 3H1 SV S]A213S NOI1VOIlddv 6I1-11 oN so), S310N N01103dSNI 1VNId AINO 3Sl 210103dSNI 210d 3OVd SIHl S310N N01103dSNI SVO HJl021 . .•..- MASSACHUSETTS UNIFORM APPLICATION FORA FE MIT TO PERFORM GAS FITTING WORK . .�` CITY5") G T Q 0 MA DATE ZE- 1— 5_ JOESITE ,ADDRESS , OWNER'S NAME GOWNER ADDRESS _, .ESS % :C7✓ e TELze /-7, 's*-5 ^ YT , OR 5 0 Fes., �- ,,�� OCCUPANCY TYPE COMMERCIAL'S EDUCATIONAL ❑ RESIDENTIAL E CLEARLY NEW: ❑ RENOVATION: j] REPLACEMENT: 34, M PLANS SUBMITTED: YES 0 NO air APPLIANCES 1 FLOORS--f BSIvi 1 2 3 5 5 7 0 BOILER 9 11 I.I 12 I3 l,, BOOSTER CONVERSION BURNER _.1 — — COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE i FRYOLATOR _ FURNACE I GENERATOR GRILLE . INFRARED HEATER JUL O 4 2022 LABORATORY COCKS L - MAKEUP AIR UNIT — OVENBJILUING L 5ARTSTEtcrr POOL HEATER ROOM ! SPACE HEATER ' —#---- ROOF TOP UNIT ` TEST UNIT HEATER _ LINhJENTED ROOM HEATER WATER HEATER - _ OTHER I INSURANCE COVERAGE I 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 W' 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 Laves, and that my signature on this permit application !Naives this requirement. t CHECK ONE ONLY: OWNER ❑ AGENT El •-.. SIGNATURE OF OWNER OR AGENT '"1„ 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 L w . , 7 ,_ .-, PLUMBER-GASFIT f-ER NAME r( C/6 C SIGNATURE LICENSE # k j) ...._ fl-- — MP ❑ MGF ❑ JP [TA JGF ❑ LP it ❑ CORPOP,ATION 0 4 PARTNERSHIP ❑ # LLC ❑ COMPANY NAME 1 " Ai-'/r\ ADDRESS 2 7 °''r\cli-) 1,4.--1 ,, CITY c7 (\ rl ‘ S STATE VA ZIP 6 Z 6, fJ / TEL .7 ) Y ✓ �2 FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES PS THE PERMIT ❑ ❑ • FEE: $ PERMIT# PLAN REVIEW NOTES • _ A i