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HomeMy WebLinkAboutBLDG-22-001511 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i‘1/4:, f. CITY YARMOUTH MA DATE September 16,202 PERMIT# BLDG-22-001511 JOBSITE ADDRESS 121 MAYFLOWER TERR OWNERS NAME MANNING GERALD TRS G OWNER ADDRESS MANNING MARIAN B TRS 121 MAYFLOWER TERR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ 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 ❑ 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsna efwinslow.com S31ON M31A3H NVId # $:33d ❑ ❑ 11Vg$3d 3H1 SV S3A$3S NOI1VOIlddV SIHl oN saA S310N NO1103dSM 1VNId AlNO 3Sfl H0103dSNl 210d 30Vd SIHl S310N NO113 dSNI SVO H0f102d MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK II _mass =. _ _.. ._ . �_-_.....w.....____.... "�_ CITY i . YARMOUTH ...V.l MA DATE 9/9/21 PERMIT # ZZ ( � t t� n 4/ . _ aWavr..wivexow... JOBSITE ADDRESS 121 MAYFLOWER TERRACE, S. YARMOUTH OWNER'S NAME GERALD MANNING GOWNER ADDRESS SAME TEL' 5083648700 FAX TYPE OR -. v PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: . REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS—) BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER 0 COOK STOVE DIRECT VENT HEATER DRYER ., FIREPLACE V' FRYOLATOR 1 I ri ice•!^ i.r I rURIV-NuE 1 GENERATOR GRILLE x INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT p OVEN E POOL HEATER � ROOM / SPACE HEATER ROOF TOP UNIT TEST 0-.), UNIT HEATER . UNVENTED ROOM HEATER WATER HEATER OTHER . . f 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 i OTHER TYPE INDEMNITY ' I 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 I AGENT 1 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 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 ,....._i MP v MGF JP JGF LPG! CORPORATION i # 3281C PARTNERSHIP # LLC # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 CELL N/A 'EMAIL INSPECTIONS@EFWINSLOW,COM