Loading...
HomeMy WebLinkAboutBLDG-21-006806 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w = CITY YARMOUTH MA DATE May 24,2021 PERMIT# BLDG 21 006806 t►a f JOBSITE ADDRESS 232 SOUTH SHORE DR OWNER'S NAME nick shaink G OWNER ADDRESS 232 SOUTH SHORE DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 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: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El 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 0 JGF❑ LPGI ❑ CORPORATION El# PARTNERSHIP El# Lc 0# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanyAgmail.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 • 1.:14' ;CITY '�: (, Crc C�tt `,; MA DATE ����7/ PERMIT Dr JOBSITE ADDRESS 0/ 3 dZ -SC>• 5h c l;� - - •OWNER'S NAME iu t Ct< 5 elA(AiK GOWNER ADDRESS .' /' TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL / PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: - PLANS SUBMITTED: YES NO le' APPLIANCES 1 FLOORS—. BSM 1 1 { 2 3 4 5 8 7 r 8 S 10 11 ; 12 ( 13 1 BOILER I I I 1 BOOS ltK - = 1 I I 1 CONVERSION BURNER •COOK STOVE 1 / i I- . - I i DIRECT VENT HEATER 1 1 - , DRYER _ { f I FIREPLACE [ . 1 E I I { FRYOLATORFURNACE f ! - 1 I i .. . - . k I I I I . .. GENERATOR L I 1 GRILLE I! I I INFRARED HEATER _ i I 1 I LABORATORY COCKS .I __ - - MAKEUP AIR UNIT I I ,_I OVEN . I I •I POOL HEATER " . ROOM I SPACE HEATER I I I I I _. ROOFTOP UNIT I 1 I • .� TEST - 1 UNIT HEATER I i j . UNVENTED ROOM HEATER I I - I I - I - -—- WATER HEATER • OTHER 1 I 1 I . . . - — I 1 1 1 1 I l k INSURANCE COMA I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL Ch.142 YES .V/NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE ••PROPRIATE BOX BELOW IABILITY INSURANCE POLICY V OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the I - rance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application wai - this requirement. SIGNATURE OF OWNER OR AGENTCHECK ONE 0 OWNER AGENT •I hereby cer`tiry!let he all ai the tletaits and irrio«rr�licn I have submitted or er7terzd r and that all plumling work and tnstallatlons per clmtec under the nnIt 1s5UAd forthisis this !i•-,•.prratton era a ar al tape a 'Cr on of Imeljg Massachusetts State Plkmbina Code and Chapter142P n will Te rn pJlarc�sy II >1i ro an of the ofthe General I awe. PLUMBER-GASFIT i ER NAME ANDREW LEIGHTON 1 LICENSE 16130-M SIGNATURE MP I MGF JP JGF LPG! CORPORATION f T 373BC PARTNERSHIP - LW # COMPANY NAME HALL OIL COMPANY INC. ACDRESS 435 RT 1 CITY SOUTH DENNIS STATE MA ZIP .4680 T� 5p8-398 383 i FAX 508-394-3�Jo8 CELL aVIRIL hallcikQmisany@gmail.cotn /o /c Bc, x <' _ .� �R x t) ) ./ 5 y- �'e ,040 �Y �LJ