Loading...
HomeMy WebLinkAboutBLDG-21-005443 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE (March 22,2021 I PERMIT# BLDG-21-005443 JOBSITE ADDRESS 1 PINE REACH VILLAGE OWNERS NAME anne girardi G OWNER ADDRESS 1 PINE REACH VILLAGE YARMOUTH PORT MA 02675-1470 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El 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 it 12298 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION 0#[ PARTNERSHIP 0# LLC❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 _I TEL FAX CELL EMAIL inspections(7efwinslow.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e auk :7 CITY YARMOUTH MA DATE 3/19/21 PERMIT # __ s JOBSITE ADDRESS' 1 PINE REACH, YARMOUTHPORT OWNER'S NAME ANNE GIRARD! , j , G OWNER ADDRESS SAME JTE77499483O8 FAX TYPE OR ;..._._ PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL e CLEARLY NEW: RENOVATION: Ej REPLACEMENT: ' ' , PLANS SUBMITTED: YES' NO I APPLIANCES -1 FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER „ii CONVERSION BURNER ' COOK STOVE DIRECT VENT HEATER .._.. DRYER N FIREPLACE FRYOLATCr: FURNACE 1 GENERATOR GRILLE INFRARED HEATER to LABORATORY COCKS MAKEUP AIR UNIT ''J OVEN ti POOL HEATER ROOM / SPACE HEATER , ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER x� WATER HEATER 1 OTHER • ......:....:................,.1............._.. ,... ....H..w...,,,........,..,....,, www.._.,._,,... ... f PC{{Ml<4ti... SS.0.n (,K • .,SuS A`',GC1�csi N:cS", h�i+iMG ffi "g4W tr.'k,. .. .. ''. ...2". ...... _.. ....... ................. ...... .. „,,,�aoamww.,4414.4..xw..... o , ::*nvw MM.4:.w..w:*vnmwv.,..a iVN....,, ..... N1ae�vh,: 44. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 1,,,,i„,1 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 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 72,1 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. I ` T ,4'r"IL PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE # 12298 j SIGNATURE MP ' MGF JP JGF I, LPGI CORPORATION 'J# 3281C PARTNERSHIP # 1 COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE i CITY SOUTH YARMOUTH I STATE MAT ZIP 02664 TEL508-394-7778 FAX 508-394-8256 CELL!N/A ;EMAIL INSPECTIONS@EFWINSLOW.COM