The URL can be used to link to this page

Home My WebLink AboutBLDG-23-003018 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 02,202;PERMIT# BLDG-23-003018 ....II..,.'�• 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 ISJ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 1 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 0 MGF❑JP 0 JGF❑ LPGI ❑ 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 halloilcompanv igmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ID ❑ FEE: $ PERMIT# PLAN REVIEW NOTES _ 0- r - _ . . 6,0. . ---------- KN.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Isf j� o _L x . CITY G I M O UQ�G MA DATE l l o Z 3-- 1 P ,,._-,�, �._ -<u _.._ , ___ .�. _ PERMIT �v - JOBSITE ADDRESS _ 614a, -- .1 -v _ ! OWNER'S NAME r --- -- - --- i GOWNER ADDRESS r___ ` ` t 1 TEL150 5R 66 (FAXF TYPE OR OCCUPANCY TYPE -- COMMERCIAL PRINT EDUCATIONALRESIDENT#AL CLEARLY NEW: RENOVATION:0 REPLACEMENT: Li PLANS SUBMITTED: YES n NO�y APPLIANCES 7 FLOORS-' 8SM 1 2 J 3 4 I 5 ' 6 7 T 8 j 9 I 10 T 11 12 I 1 14BOILER :; — t . _ V ( .g I- .. .. .BOOSTER - � t _1 ,� - f lti '1 ''CONVERSION BURNER ., _ COOK STOVE ,i-- DIRECT VENT NEATER . .r - _ s - __ _r :�.� .� t� ' �' t `r _ _1 .[.�.�^� S.Y.s.o >F...- 4S•_-=c._ Itr.. _' ._E' - :.+C.�..E _ ice ✓ DRYER - . — r .:_,____,...: 1:______,..,..„-_____. .....,._ _ FIREPLACE - .1,.'- V=�� - _ - ' =M .:i _f• = • FRYOLATOR � j — ._ ._. _ FURNACEv r :_..___._ _, r s - . � • r, --�'�,-= - r��..1 1 .�r1 _-.F 'i. 1 _ , �� =- GENERATOR 1 r• — -r.� _ f r Ft _� - GRILLE f INFRARED HEATER . ._`I�_ -- �.w3 fr- LABORATORY COCKS r = t.__ ��::. _=' -> •__sL +T�_ `:,�.�y. ]::crii_— MAKEUP AIR UNIT � _ �, , -�..f r = �_.. _ • _ ._ r�. �._. OVEN -- __ _ _ i . :' —(( �-_�. '.ry.J'w �Ir.r..4...-�., FF (1 ..«p.' .. 2.�,.. �-�1I t —_ ^-� i HEATER . _-- - _..,�..��,..,1= ,.ti, �. _ ` -- -=` �i ._�r__ _I -_ POOL �= =. -_ _ '- -Y� : ROOM/ I._ . . � ^� a SPACE HEATER - _.. _ _ r a >.= r..a._.._.+ 3 _FILE i '^_' 4 I ROOF TaP UNIT - - _ifz ._.�s�. �'_r_ --r_.w �._ :� ..__.1 i s I i TEST -_ - _-.e-<- — • :u _ I fir---,-- UNIT HEATER ��.T.a. L K ,�r.. - •, I _ .T . _i _ I. UNVENTED ROOM HEATER __. _.�., f,__�,.. - - ~ .... _ _ :r_ , ,. -_ .. . S = -TM� �1�1 WATER HEATER ,. _ .�.e �..w_ _ __. .�- -._.� OTHER ��L ._ t - r'�__. Gw_.cfF.�.�ii .01Mswil _ " .,. . :., „___ :-WIN-' -�_ _— _�Ci+--..-.-- ..�,�.� � -�r=�c -�,fr.--{�.... '...c._;.i..: .—T. 'T.toF�:t�. u•._;..�:....��.._..__,.-._. ' +t INSURANCE COVERAGE i I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES 2 L I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW . LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY [] BOND ( 0 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 my signature on this permit application waives this requirement, p SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER r� AGENT L I hereby certify that all of the details and Information I have submitted or entered regarding this appticati are tru�and curs o the st of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will a in com Banc with Massachusetts State Plumbing Code and Chapter 142 of the General Laws. p Pertirt t provision of the 2 PLUMBER-GASFITTER NAME ,U/� i° r;./ `- LICENSE # mac SIGNATURE `� ...-----1,......_...-----1,......_-_-_-_- MP F+ MGF 0 JP U JGF J LPG! 1_ ( CORPORATION ` n s) 'ijPARTNERSHIP ---- # C -- �� LLB��# COMPANY NAME: }xx ate: CO . i, e I ADDRESS CITY 1 S' _ ` ,� , 5J .._.. _ I - ..•�.-- - - STATE C 1TEL 0 ' _ 3 3 [ FAX gJ CELLI _ _ . _ JEMAILV/ _,,-2 . ,A,-,,,,,,246/... ,,,- , ,;,,,--,-' ,:-.1,-- -/.27,4_, c_c_----e---- •