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Home My WebLink AboutBLDG-22-001589 -.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 5� —.� CITY 'YARMOUTH I MA DATE September 20,202 PERMIT# BLDG-22-001589 JOBSITE ADDRESS 23 EDGEWATER DR OWNER'S NAME GAUCH DONALD J _.] G OWNER ADDRESS GAUCH GAIL A 23 EDGEWATER DRIVE SOUTH YARMOUTH MA 02664-2200 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 1 - - GENERATOR 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 BOND 0 OWNERS 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 Stephen Winslow LICENSE E 12298 SIGNATURE MP 0 MGF 0 JP❑ JGF 0 LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME. STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA J ZIP 026641207 TEL FAX CELL EMAIL inspections(a?efwinslow.cam S310N M3IAaI NVld #lM3d $ :333 ❑ 0 iIIAJ d 3H1 Sd S3/1a3S NOLLVO lddV SIH± oN saA S310N NOI103dSNI 1VNId AINO 3Sf H0103dSNI N0d 3OVd SIH1 S310N NO1103dSNI SVJ Henan MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `$ CITY YARMOUTH MA DATE 9/13f21 PERMIT # i t 7::H.' .. .,..,,...... _.. __ ...,,.,...,..,�.,....,.,.. ..__. JOBSITE ADDRESS 23 EDGEWATER DRIVE, S. YARMOUTH `OWNER'S NAME DONALD GAUCH �„ OWNER ADDRESS SAME' TEL 5083984781 `FAX ,.r..._ d,3� ,...,.:.,, ._. ::.;..,.. ,:�:,„:.cwea�aattuxuu� aa�mx�cacewFR TYPE OR OCCUPANCY TYPE COMMERCIAL , I EDUCATIONAL 1 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: 1— REPLACEMENT: PLANS SUBMITTED: YES N0 APPLIANCES Z FLOORS-i 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 s. FRYOLATOR ' FURNACE 1 1 '= GENERATOR 'I GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM l 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 l,i 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 r ` 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 accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ' STEPHEN WINSLOW # LICENSE # 12298 SIGNATURE MP v MGF JP JGF LPG! CORPORATION i # 3281C PARTNERSHIP # LLC # �_* s�J COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING l ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL FO8-394-7778 FAX- 508-394-8256 CELL N/A EMAIL' INSPECTIONS@EFWINSLOW.COM