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Home My WebLink AboutBLDG-23-001636 7 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE [September 27,202 PERMIT# BLDG-23-001636 0 JOBSITE ADDRESS 67 MERCHANT AVE OWNER'S NAME BRENNAN ELAINE C G OWNER ADDRESS HAMMOND CHRISTINE L 67 MERCHANT AVE YARMOUTH PORT MA 02675-2238 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 I 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 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❑ 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 or the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Andrew Leighton LICENSE# 16130 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME: IANDREW R LEIGHTON I ADDRESS. I20 Brewster Rd, I CITY IW Yarmouth I STATE MA ZIP 026735706 TEL I I FAX CELL I I EMAIL IhalloilcompanvWpmail.com I S310N M3IAa1 NHld #110113d $ :33d ❑ ❑ 1MH2d 31{1.SV S3Aa3S NOIIV011ddV SIHt oN sa,i S310N N011O3dSNI 1VNId KINO 3Sfl N0103dSNI dOd 30Vd SIHl S310N NOI103dSNI SYO Honal r_ / - _ , & MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ! CITY „}�G�rirt0 MA DATE " - - - PERMIT # t - ` I"`��o JO8SITE ADDRESS _..67. . C c4 g+-.R-- #4✓ __, I OWNER'S NAME [ f4.:n e Or— et,1 G OWNER ADDRESS 2 v ej ' TE sad 3� - 9 'Fax��" ,L".�^r,.�--•^=r�'rrrL�rr.,•r•,:--�v..•..-•r..'r✓�a.'.,c_.`:--........__ .-.....-y . .- _�. -c..16:.x--rrs.•,=.... wr=t TYPE OR OCCUPANCY COMMERCIAL El EDUCATIONAL f RESIDENTIAL PRENT �..�_ CLEARLY NEW: RENOVATION: Li REPLACEMENT: E..1 PLANS SUBMITTED: YES NOL APPLIANCES -1 FLOORS-t BSM 1 • 2 3 4 5 6 7 8 9 10 11 12 13 14 . 1. 1.z-if --. BOOSTER - r _ _zv� __ _ I- • `. .. r�+v.- --_•. .rr.. _ .-wc •ram:..-e... i i�r---• 11.:-. v'i CONVERSION BURNER �-- +w..� ;�--- _..� r COOK STOVEz _ '._�. :_. — r_..�., DIRECT VENT HEATER �',.�• ` _ .. .._. .. _ s_ _ -. +: DRYER �>. _ .x- .�_.y,_ .,<_ --_ - -t �.sr _ - _� __� s_ . . .. _._ f �Y, ,__ ---• •-..,.rt v- - `� - - - -r ..r'.•r,v,-q...-.,vinE ,-,e-..y'-.n..r :..: i'� .....sue.. .. FIREPLACE __ (�__ �i• i _ - E � ; _ RYOLATQR ,`.�_..�.� - _ k; ?, T-cta� �,. 3 FURNACE __-__ i _- -- _ i! . - ; `�..-� , ._ . r ,r____�, r GENERATOR .i • -;_- _ _. - t. . GRILLE IMMINr • �� '_ I I `i� T INFRARED HEATER _ �I',.�.�,,F_` -.._ -.- -- ..•.,.. °-- �r _ _.-� __ ��(��_ `. , i•_"'='1 i+r •f-•. r. _r�1==: .-•`-•r- ,':1 .;-��-a.-•...,;;. �.-,..,.- •` •r'r- , -z.• -u r.,. i I,. LABORATORY COCKS I - ` . . r , MAKEUP AIR UNIT ; - I IIIIIIIt f_. I r. _._ I I a jr OVEN s _, j ,. � If - .i•:/r1'-•--r - `.-,...- _-:ta=!!•rw-.- --..ar4, -� a.,•r- `! -_,1 `! -- i--z- ? -- - POOL HEATER F, ,• _ ROOM / SPACE HEATER � i w.� ' =-�,_r~ fI > ` __1 �r •7� •...r - . �... r .. ..s-� ___ -rr.a.-}Ic:--v.;-.:. �1.._r._w- cc.a--..._.!•'.F+.+_w r,_,79'-F Tt -.---'''' ,,..t 1,�,�'•1,.`....,.�_[ ROOF TOP UNIT _t I I_M i TEST lis ._ ... . UNIT HEATER (( - ----� � .,.�,.. ,. � � _ �....._... . ,,,.�. !f�=s�y� ._ -a,r�r- r=r_�_ _ _..•,- , .vnry-.. j,.�, �:.. - ,-, ., _.. �_ _ ' Y:....J, .r. r 7_______ �. ,-jam -.Y .•rY M' 3..�.�_ UNVENTED ROOM HEATER ';, W�:�,. - }�. �f ► �_ �� `�_�__ _ fir.... t . . i .J WATER HEATER � t -- {• Y.tr T-�. (�(��I i hw'L .�• '4tli�L Li-- f.:- .4:r.t«-=_ .Ir......._ .+�I(•_T.• _ •-1��•TiNiS __.. -. t ��:• MF:�•.�^•:.n-�V_.� ;.�- �' OTHER ..,. } t . . ; �_i r—li. ,. ....._,._.....-....,.-. �n....ew..c.... ...-._. .err. ........._.- r.as. .. - - .. -.. -wc:•c::--.,.--�.r.r..(r .......- _.c.�_„n=.... .. �....._..... 'a.�.a.r::��r.e....-.-.�.--..•ry r'��r•�:�-' II I .:.c.r.a...,i ,--_.�-.:s,,..1,«.. }�.r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES . NO Li I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ✓ OTHER TYPE INDEMNITY Eli BOND 1 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 icy signature on this permit application waives this requirement, CHECK ONE ONLY: OWNER L AGENT i�_.. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appiicali are truand cure o the st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will a in comp land with Perlin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME f�!>i' ef v �' --`• �� 2. 6/1 i f LICENSE #( uoc• .0 SIGNATURE ,i MP F MGE L. JP r7 JGF'1j LPGI 1 j CORPORATION F(# 3). C.:1 PARTNERSHIP[_i# j _ _LLC # _ r COMPANY NAME: XX Piz; Co - r c...._ JADDRESSLj CITY S - %,,In I s STATE i e19 ZIP ("i�Li✓ C ,T EL { ,1 :12.41 - 3 3-3i ---] FAXL ., Z 07, CELL IEMAILV,./.4i7(_-_0_41.-A.R_Rly�v' e---!e1!�i4.� C- c- - 77-'.