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Home My WebLink AboutBLDG-21-005637 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -(s BLDG-21-005637 : (e CITY YARMOUTH MA DATE March 30,2021 PERMIT# JOBSITE ADDRESS 39 CHANNEL POINT DR OWNER'S NAME KENEFICK JOAN E TR G OWNER ADDRESS CIO THE STORAGE SHED;ATTN:FRANK 275 BAILEY ST CANTON MA 02021 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 ❑ NO❑ 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride(a gmail.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 J' f g; ,` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �I_ -�— / i •- CITY _ A .. ,Ci . /�Q LAj I MA DATE •3 3G' c (PERMIT#B -0 —�( s6}l J08SITE ADDRESS /T 1n lE' L #COI n7- i OWNER'S NAME i G --z-I- E� �`ic L( GOWNER ADDRESS ; 7 7 j T_�5 J,_ ___43171 TEL - J/ FAX -- - TYPE OR CC,, 7` -00 I. - 0 Z 0 2-2 PRINT OCCUPANCY TYPE COMMERCIAL _ EDUCATIONAL _J RESIDENTIAL* CLEARLY NEW:J RENOVATION:J REPLACEMENT:4. P l F-.{-(/m'S PLANS SUBMITTED: YES K] NO I APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _,I l I__J__1.__J___J____J-J-__J-J_J__1_1_I BOOSTER __J- 1_1_1 Tt_1-J_I•_-f-J.J-J_J 1 J CONVERSION BURNER 1 __J 1_J I._1__I 1_J _J_1 I: ___1COOK STOVE ,._-__I I__1 1 1',-___.] ] .-J_IJ J_I 1 _-f DIRECT VENT HEATER I _LI_J; J _J 1 J_J (_I I_J DRYER- :__!_i-J J_-I-J_ 1 J -_J I_1,____J_-1 1_1_J FIREPLACE I_J_J 1 J _1 _ I _ I I . I_J-J_J___J FRYOLATOR ! 1-1-J_ 1. 1 J -_J i I _I_1_,I�J_1 FURNACE _J____J I I__I I GENERATOR !_ I I I`_I I___ J �J 1____J_-J_ __!_J_ GRILLE ____i I,_ _1_J__1 ... I 1_J. !___J _J___J __J __1_1 INFRARED HEATER . ._.J_J-_J 1- 1___1_J ,J _J_J____J____I__-_1 LABORATORY COCKS 1 ___._i !_i__.! I_J.__I Y__I_._._J r_1 __..1_I I_J itMAKEUP AIR UNIT ._ i 1—1_�J_.Lj____J____J _J _Li 1-J I..___J:___1 OVEN J__..__1_ I I J__J___1 i_1 _J__! .._1____I____.J___1 i POOL HEATER _J__I___._J___I I,..__-__I____J 1____I_J_._____1,.J._.__I____ J_1 ROOM/SPACE HEATER ___J ' I___J I I_ I_ i i I 1 ROOF TOP UNIT _.__.! I 1 _J- '^J___J _..._! -J .__J_ J__1_J TEST i. i i ?_ I __.J_.___J i 1 ; i 1- - I UNIT HEATER __I I 1 I _ f -_.J _4...... J_1_1 I___J 1-j UNVENTED ROOM HEATER ___J___1 1 1__I ! 1_ j I____J __I ___1 WATER HEATER / 1/01j e-Lr- J .J ( 1 I!.J J !_____J__ .___J J I 1 J___J OTHER . J I i 1 1 1-._____ ! I 1 I ___J_J-J 1._..J -J . I J I 1 __JI�I__J_._I ___.J__I_1_J'__J_I__.J 4 1 J___.I__I_J___._J I 1_J J 1_.__J I__J .. I_..i 1 __J. • 1_.__1___u1 I _____J J 1 -j_1 I INSURANCE COVERAGE CI have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES It(NO I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1L OTHER TYPE INDEMNITY .J BOND LJ 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 '^.I AGENT _J 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 n compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. a ` PLUMBER-GASFITTER NAME,I,�/^1 t LC r•(it-cif c. I._ r i . r LICENSE#n�? 7 j 1 SIGNATURE MP _J MGF',_J JP:gk JGF J LPGI _J CORPORATION ]#' n(- 6-13-1 PARTNERSHIP!I# I LLC J#` I 1 COMPANY NAME:: rJ f t P 114 I ADDRESS 9- V (/z Tl C •0 r< _ — _ CITY -.L../ ✓i."6 r- A c) 41. 1 STATE., A,4-(ZIP J'l� 73-jE TL ? �/- /l/ 9-( Za_ FAX CELL. EMAIL .3 .P cp- -e C r , ) -i`, C 0/h I