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HomeMy WebLinkAboutBLDG-22-004995 MASSACHUSETTS UNIFORM.APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tr - CITY 'YARMOUTH I MA DATE (March 09,2022 I PERMIT# BLDG-22-004995 JOBSITE ADDRESS 89 ACRES AVE OWNERS NAME Jason Cassidy G OWNER ADDRESS 89 ACRES AVE WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 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 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 1 OTHER DESCRIPTION:relocate piping INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ 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 of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 'Stephen Winslow I LICENSE# 112298 I SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! 12 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'STEPHEN A WINSLOW I ADDRESS. 18 REARDON CIR, CITY IS YARMOUTH I STATE MA ZIP 026641207 TEL I FAX I ICELL I EMAIL :nnpectivnsISeinvIow corn S310N M3IAR NVld #iM I2d $ 333 0 ❑ .IW2l3d 3H1 SV S3A213S NOLLVOIlddV SIHL oN saA S31ON NO1103dSNI 1VNI3 A1NO 3S(1 :10103dSNI 803 3OVd SIH1 S310N NO1103dSNI SVO HOflOd MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 22- LIcr- a %,s ties,itiff CITY YARMOUTH MA DATE 3/1/22 PERMIT # \t,4 \:7:- , - ,_,, ,„ _.,„____„_,,„ _, ,__ ,„ „_ JOBSITE ADDRESS 89 ACRES AVE, WEST YARMOUTH OWNER'S NAME 1JASON CASSIDY G OWNER ADDRESS 150 HUNTINGTON AVE, #SL-11, BOSTON MA TEL 7816862948 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-0 I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER 0 CONVERSION BURNER Pc COOK STOVE DIRECT VENT HEATER I DRYER FIREPLACE kr 1 FRYOLATOR — , - FURNACE GENERATOR . GRILLE _ 00 INFRARED HEATER p LABORATORY COCKS lb MAKEUP AIR UNIT - U OVEN _ POOL HEATER , 6 , ROOM / SPACE HEATER , n ROOF TOP UNIT , n TEST l�' UNIT HEATER UNVENTED ROOM HEATER WATER HEATER ___. OTHER ; s bC 4-•[ � _ r iczi-1,-,ma.A.„1,4.... . 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 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 AGENT .,ww a, 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 accurat 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. / --, ,...,o .„ PLUMBER-GASFITTER NAME i STEPHEN WINSLOW LICENSE #[ 12298 1 SIGNATURE ................................ MP i MGF JP JGF LPG! LI CORPORATION 71# 3281C PARTNERSHIP -1,#L... LLC # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING iADDRESS! 8 REARDON CIRCLE CITY LSOUTH YARMOUTH i STATE i MA ZIP 02664 TEL 508-394-7778 FAX; 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM