Loading...
HomeMy WebLinkAboutBLDG-21-006858 #11 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 25,2021 PERMIT# BLDG-21-006858 1i ". 11 1 NEW HAMPSHIRE AVE OWNERS NAME aul Cruz JOBSITE ADDRESS & 5P G OWNER ADDRESS MA 02021 TEL 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 1 , DIRECT VENT HEATER DRYER , FIREPLACE 1 , FRYOLATOR FURNACE GENERATOR , GRILLE INFRARED HEATER , LABORATORY COCKS r MAKEUP AIR UNIT . OVEN , POOL HEATER , ROOM/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 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 0 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 Ryan White LICENSE# 16068 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RYAN L WHITE ADDRESS. 19 SKIPPERS DR, CITY Harwich STATE MA ZIP 026453122 TEL FAX CELL EMAIL rwhite10110gmail.com • ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES film) {� 4-- RciEL.' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK g- € CITY r�w�+b''�, ------_-1 MA DATEa:-yjL:IL. PERMIT# 0G-21 - °o°9JO6SITE ADDRESS it AJ 2 tlC -,, OWNER`S NAME � — - `.��� ___, �J � � -x-r.Y_.. -�i1-.T/•V"--C-l-7'L'Jam" .. GOWNER ADDRESS --- ---- ---- j TE,rFAX TYPE OR OCCUPANCY TYPE COMMERCIAL . .- EDUCATIONAL PRINT C LI RESIDENTIAL[ CLEARLY NEY: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES Ho APPLIANCES 1 FLOORS-6 BSIA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER �- -- BOOSTER i . ♦ ., _ _ �_-____ �4-.. '',^i+�2'. to I CONVERSION BIDER _ 7 1 t � DIRECT VENT HEATER _.�. _ _ - ; �p COOK STOVE --- - a _ . .. - FIREPLACE u_.�._.' _ �-- _ E, F�yR OOI ATUR E- __ _____ .... GENERATOR . GRILLE i 7:`� 1..s-.z_s1 .-ac.,.,•.� , a-.. r.v.+-`�.: ':'tz-•':- :n ►- s .�- -„..-., =r..— ram.-. -..„- .__._.! -t.�= � - �..- RARED HEATER •t ,a.c.✓... ___- _ sv=s_ .. LABORATORY COCKS MAKEUP A U 1 i t r ...,.,.......y. ..„..L„,,....__ - POOL HEATER ..ram•',}' - :..,._ ;AcF'" Yxi� .:a t ROOM t SPACE HEATER v� "� = �__ - ROOF TOP UNIT ,,,, is TEST -- - E -� - _ __ _ r ..x UNIT I CATER - -. �- -. _ . -T _- - . UNVENTED ROOM HEATER r - -- HEATER ._+-_.. 4,- WATER4 OTHER __ a. -. t , ti 111 ..—.- �� t _ __ _ ...�..._ w _ : ,..�..�_.... ..�.�a..-r�.�,._.a—•,.�-..�,.._cr . .�-_-r �,. < <_ .. -., ..,_.._ ._-+-_� .. _ _-.._ ...__ . .. __ -... --.- a-cars. _— .:..-...Jr.•_. -,a.,t r �.�a..-F.. ��z2 a-,.tr a ... ' INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 YES 7 NO [A I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW K_IABII_iTY INSURANCE POLICY OTHER TYPE INDEMNITY [_] BOND [ OWPWR`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 [-_.I AGENT L I SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and infotmaaon I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing viork and installations performed under the permit issued for this application wiM be in compliance with all Pertinent provision of the Massachusetts Stave Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME �, a ,,d 1� I I LICENSE 4-6,/ Qj---------r sIGNAT E t,___ is nimu Li JP n JGF I_„_1 LPGI Li CORPORATION of[ __.___.., PARTNERSHIPLIC.,_. A U-C r # ________A _________ COMPANY NAME _ (-- J ADDRESS Leo ocsCITY L ii,, , ,' STATE .a._—.���. WI ZIP� v ZG�5�__---_-��TEE. FAXL...... 1 CELL g),,,,.....----. EImIL ° ,