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Home My WebLink AboutBLDG-22-002935 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e ¶ CITY YARMOUTH MA DATE November 19,2021 PERMIT# BLDG-22-002935 If ' JOBSITE ADDRESS 17 CAPT SMALL RD OWNERS NAME BRODERICK CHARLES M REV G OWNER ADDRESS JOYCE PETER REV PO BOX 939 RUTLAND MA 01543-0939 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ 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 1 FRYOLATOR FURNACE GENERATOR - 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 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanyCa.4mail.com S310N M3IA321 NVId #IRAN% $:33d ❑ ❑ 1I1N213d 3H1 SY S3A2f3S NOLLVOIIddV SIHl ON saA S310N NO1103dSNI 1VNId AINO 3Sl 2J0103dSN1210d 3OVd SIH1 S310N N01103dSNI SVO Hol021 ci" MASSACHUSETTS UNiFOR M A.PPUCATION FOR A PERMIT TO PERFORM GAS FITTING WORK j 7 -----_--- r i1cm3y' 4kt973 '00%K MA D T E /I i g ,A/ PERMIT# `Z2 - 2`l 3 S JOBS I T E ADDRESS ) eoyi S // , - OWNER NAME e OWNER ADDRESS T L PV 1 )-0„9 36 FAX TYPE OR ` I OCCUPANCY TYPE COMMERCIAL IAL EDUCAi 1NAL RESIDENTIAL CLEARLY NEW: RENOVATION: r E t CEME PLANS SUBMITTED: YES NO APPLIANCES . FLOORS- 1 3SM i 1 i 2 i 3 t j 5 f 8 1 7 i 8 I S I tQ 1 i I 12 13 14 ir BOILER 1 i + BOOSTER + I ! } t i 9 _ CONVERSION BURNER I COOK STOVE I - t - _ i . - _ I # E • DIRECT VENT HEATER I ! I I f DRYER i i --- t E f FIREPLACE 1 ! _ - f k FRYOLATOR j - An f } i ? GENERATOR i - ! t GRILLE I .I I .. E _ ] I INFRARED HEATER I _ - ` - I € _ t LABORATORY COCKS ._ . _ s -- . MAKEUP AIR UNIT ` _ ! f ; OVEN _1 . i _ _ { - ; 44 POOL NEATER 1 V V. . t - - I - t 1 . ROOMI SPACE HEATER i i - _ .. _ ROOF TOP UNIT I i . ; i I - __ TEST } 474 _ - 1 I _ f ___ UNI- t . . E INVENTED ROOM HEATER ; ; '; 4 '�� I . _ - -_ WATER HEATER - ' . I . 1 i _ - - 1 1 } . . - - - OTHER - � I -i —{ i INSURANCE COVE COVERA t I have a current iiabilitY insurance policy or its substantai equivalent.whish meets the requirements of MGL Ch,142 YES 1 NO I iF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE SY CHECKING THE . PROP LATE BOX BELOW LIABILITY INSURANCE POSY it/ OTHER t=INDEMNITY BOND OWNER'S INSURANCEWAIVER: I am aware that tile licensee does not have the I - range coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application wai --=- this requirement. i CHECK ONE 0, ; OWNER AGENT 1 SIGNATURE OF OWNER OR AGENT • 7"1 E hereby ce r tt ail aF ate it cr£ have suited or ert�recf r�� afar are = arl : �. _ of my imQwledge aril that ail plum l ooric e d Instal .4 rss pc - . 11 i Err er I3 fe i €stied for ihis appli ==i-n will b . 'plia t , I3 1.,AQ- • c f the Messachtjse s State Pi bing code an ChapLr 142 of the G�erzi I..- . 2 t - liW -- PLUMBER GASFIT T ER NAME ANDREW LEIGHTON UCENSE •- 1 Elsa-M SIGNATURE MP e MGF JP ,;GP I CORPORATION PORATIO I T 3734C PARTNERSHIP # LW COMPANY NAME: HALL OIL. COMPANY INC. ADDRESS 435 RT 1 cI T Y SOUTHDENNIS STATE MA ZIP #:'.,0 TEN_ $-39$-3 3 i FAX 508-394-3068 CELL =.IL �Io c mp nyo�,?gm jLcom