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Home My WebLink AboutBLDG-21-001729 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 05,2020 PERMIT# BLDG-21-001729 JOBSITE ADDRESS 24 CAPT DORE RD OWNER'S NAME THELL SANDRA M G OWNER ADDRESS 24 CAPTAIN DORE RD SOUTH YARMOUTH MA 02664-2817 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:D REPLACEMENT:0 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 I 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❑ 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 CARL RIEDELL LICENSE# 8246 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: CARL S RIEDELL ADDRESS. 778 MAIN ST, CITY OSTERVILLE STATE MA ZIP 026552011 TEL FAX CELL EMAIL 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 D Rcrc ( :• ., ,_. . . , • . . \.St --. . (. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Now aim . • �.t ,'>t 'l PERMIT # � . �i/ `�' 4 I , g CITY .__ J MA DATE. � � , , ..f; ,�s JOBSITE ADDRESS A�'�...._G • I 3 OWNER ADDRESS - T E l; .-._._�-_--.--�. FAX 1_...._......---..,.__-----.._... TYPE OR E COMMERCIAL EDUCATIONAL (__ RESIDENTIAL PRINT • OCCUPANCY TYP CLEARLY NEW: ...._.1 RENOVATION: „I REPLACEMENT: : , PLANS SUBMITTED: YES D NO APPLIANCES 1 FLOORS-► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 • BOILER ' _ril t� 11 __ I l ---11 lti _ :.--11._.—_' __: _� t -_ �A_-r�-_1 ♦ � r:._�-_. - �_tom.�_`-.-..�.._ -_ ._ _1 /(�'_'_1 BOOSTER141 BURNER - t : I _- 41---=- { q - _z-IL__. ._--. .-.-._=1 -= -...f - - _ _T.. - i . CONVERSION �. -��. r--_ --�=�� _ _ COOKSTOVE '_.___.- _-__._11-___.__.1__--- 1� . �_._._>, __Ii_..-.-_I •-_.--.-_1-____tI --- -_ _,_I--___.. ! __ _._1. ___ DIRECT VENT HEATER _-_.._.a __ --_ _,-._- - __ _ _ _ .� i 4' _1i 11 it sl: . - iL__..-__'L_ ,I ;_ _ f ..._ DRYER _._ ' ---_� _- t:_.___..._. _ -_.a -_ __!I .T i:_..._....._..:s- __ I. .I — i _ FIREPLACE ' ... �� f - _ . . _. ., FRYOLATOR1 = I , ;I 1I FURNACE1_-_�.:31_=:=,.- L.-:. -__ I-:=--- = 1--- -.,= I. . �--•.--_-. --==- -3��__--- ___ --_ -_- - =_ -__ - �1 •GE NERA - _, ill ill GRILLE INFRARED HEATER i :,, 14,1 It • --= _ -- - . - LABORATORY COCKS -- __.-- -_-.- i - € §i fi tI al _ . -• - — - 3 ' MAKEUP AIR UNIT -- -- j OVEN fl 1 - -- _ - _- -= --- -- -- - = - j' i tc POOL HEATER - , ,( #s _ -� �` - _ +,-----` - , I t ROOM I SPACE HEATER 1.- - s1 -',I ity . . •-._- -.- = -�- _ - l� l • :I� IT i 't— 1 ,—�?c am-- _ _ _..•. E .— M I� ' ROOF TOP UNIT • I_ 1_ __ '4 -_..- 1 - I 1 5' _�__... -- '�-_---.°I--- t _.,______ ` :-..----:--7-_:: _ _. - UNIT HEATER 1 ;i 11 :.1-_ 1•1 I Ei = _ _ � - - UNVENTED M HEATER `=l I £ - __ _ _ --_ .� - _ _=,_ rw _ WATER HEATER i .--- _ -.. . . _ -_ -- t { 4. OTHER > a °`i .t, .µ '_'-- --- l•—....__.-"1 .... _._ .... _ ^1.-.,_mac—y -• j =— i__ _ - ---- - - _ -. 1 :-- _;.._..�--- --- — -— I _ INSURANCE COVERAGE Ihave a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES W NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ' LIABILITY INSURANCE POLICY R 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 L AGENT I_-•.... ' 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 complia ith all Pe t provis he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - ___..;Q - PLUMBER-GASFITTER NAME I Iccx-i 5 , fp, ; e d e 1 I_-_ LICENSE #1_ y-c StG1 ATURE MP MGF JP JGF D LPG CORPORATION --2# L 0 . PARTNERSHIP1J#L_ .. LLC l_.- # � COMPANY NAME: _ c� r I i' _B • C� e I l_ t So n_ ADDRESS �7 7 I`�1 .}n .St�ee_ �� CITY O S e r u ► 1 1 STATE Vl A\ 1 ZIP I 0 a Co 55 1TEL I-_5 O S - H p. S- -_C 3_c0 5.- . .__ ----,— ------ - r ':---1---,------3 FAX': CELLI • E MAI - i • _- T - .