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HomeMy WebLinkAboutBLDG-23-005216 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 22,2023 PERMIT# BLDG-23-005216 JOBSITE ADDRESS 42 MARLIN WAY OWNERS NAME DAVID THOMPSON G OWNER ADDRESS GATEWOOD THOMPSON QUINESSEA L 42 MARLIN WAY SOUTH YARMOUTH TEL 02664-0000 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 1 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 0 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 LESTER WADE LICENSE# 4569 SIGNATURE MP❑MGF 0 JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY COTUIT STATE MA ZIP 026352702 TEL I FAX CELL EMAIL info(ilccipoenerators.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK GTY 'I arm.D(AA- MA DATE (1 1 )'�' PERMIT# JoesrrE ADDRESS '{a- M t .rF-(i` h WCL 1 OWNER'S NAME I Ccy e T k o GOWNER ADDRESS SI et- a o 6J-z TB. s 1- 3 3 N- Y t J,FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL PRILNT Ci.]R.ARLY 'NEW:(j RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO APPLIANCES 1. FLOORS-4. BSM i 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 I MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT ( " TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I " OTHER INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY 0 BOND 0 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 0 AGENT 0 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 knowledge and that all plumbing work and Installations performed under the permit issued for this application MI be in compliance ' all P i on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASH I t ttt NAME L .s+e_r o)cf.et-e. LICENSE# 5(o 9 SI RE MP❑ MGF® JP 0 JGF❑ LPG{0 CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME ""Y e_Ce tP cto,04:4-1 1-4 'Pt r ADDRESS a.3 Bay;;cto S, CITY NQS(,t/1-e. STATE AAA ZIP -( '-i TEL 60V^4F7'1-- $ -d FAX tot A CELL 5OT-350—gs-V EMAIL •1-A 'Co Cc.a?_g P_eii.i Ps Fa)4 E D MAR 2 2 2023 BUILDING utrhkTMENT By