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Home My WebLink AboutBLDG-23-003403 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I'm.? CITY YARMOUTH MA DATE December 19,202: PERMIT# BLDG-23-003403 JOBSITE ADDRESS 42 MELVILLE RD UNIT 5B OWNER'S NAME BAKER CATHERINE P G OWNER ADDRESS 29 EASTERLY DR EAST SANDWICH MA 02537 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El 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 1 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany(a gmail.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 6,T V , �_ _ _____. _ . _ 4r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I t. —� CITYY.. C .O�?-. . _ j MA BAT [-.W2://(o o� PERMIT# Z3 - 3��0 3 JOSStTE ADD RESS I_q .. e.I v1. Jam. ..f_.j._.__. JOWNER'S NAME f sic_ .l e tTe., - -_---f.1 GOWNER ADDRESS r /• `: Iot5V— Jam' / FP,XL TYPE OR p FT OCCUPANCY TYPE COMMERCIAL f EDUCATIONAL 'EllRESIDENTIALN.. I CLEARLY NEW:j_ _j RENOVATION: Li REPLACEMENT: p.4 PLANS SUBMITTED: YES O NOR !PPLIANCES 1 FLOORS-+ p,L BOILER 2 3 4 � 6 7 8 9 t0 t9 12 r3 14 -r-�- _._ i y.._. . ; z 1BOOSTER ► -� _ _ _CONVERSION ,:- — � ill�., _• _• ,if--:j___`r. ._....i• _' M , I�.� .r, E_ BURNER COOK STOVE iL - .�iv_` F ._ I 1X S r, �; '.tr.� ,:-r�DIRECT VENT HEATER -_ r—_ ,� t{ .' ✓_DRYER i , ...��: �s-s �-- �. `_ I �_ ,� .� ...,, ~ � � FIREPLACE - - f i FR`r'OLATOR - F - - -i - two/. ; _ ' I _ w_ .. � R`_._ ` . .FURNACE f :.� f�. s`- ,`_ ' 1L } GENERATOR ,r11.1-17-7 i 3 �,�_ GRILLE �` � I• � ___ ,_ _i! ._ .., :_.::,..._:,rt_IL ._ . ! ......_.__: ii.._____;.„..,__ _;•,,___ !r.,- -. 7-1 INFRARED HEATER _- �``__� ! iE ° 11 F LABORATORY COCKS I t ► f i ; MAKEUP AIR UNIT -- l, �.=---�.- f - •� — - - POOL HEATER F .��_.� ,. .. - .� ► �� `,�""�'�`'` f_ - � y. ROOM I SPACE HEATER ! �;� 3 _.- --. ROOF TOP UNIT Al TEST t t. i __IL__ ~' ':_ I ._ - I-ml_hHUNIT HEAVERnut , , _ ;! _ ---I, . UNVENTED ROOM HEATER r i ( - .__ i t; E' t ..iL� .�11 - l WATER HEATER .r----,! OTHERi. - , a _ . — — — i gun' .. l ( E� - -. 3 ....�F , , ; i n.,.Y-r- ?-+r_�s� s=.l�.� •+l��+W. , I , i: .i ,n___, INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES eg. NO J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYLI i -- OTHER TYPE INDEMNITY �# ar�Np ;- , j OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b Cha Massachusetts General Laws, and that my signature on this permit application waives this requirement, y Pter 142 of the J SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER LI AGENT lv_, l h ee by certify that all of the details and information I have submitted or entered regarding this a licati are and and that all plumbing work and Installations performed under the permit Issued for this application will a in comp mac, with - Pectin- o e t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ �� PLUMBER-GASFITTER NAME ,�� ,�U�, 1 �.! LICENSE # lam( .. - T SIGNATURE MP MGF ED JP U 1 JGF 0 LPGI (� CORPORATION # L/ PARTNERSHIP LLC __ COMPANY NAME: . -- Df� eU ��y ADDRESSL ,3 '-%� ' I CITY I ' 'n S STATE Lik—e,,,..A.Izipc-c3___L, & G TE . 5 k _,e-1 _ 3 , FAXL_W_;•;_r____.,4_ ,ZOTACELL! _, _ _ JEMAIL i f � �,: