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HomeMy WebLinkAboutBLDG-21-006637 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _� CITY YARMOUTH 3f 1� L f^eo L rs, I MA DATE (May 17,2021 (PERMIT# k‘, BLDG 21-006637 1iFi ��ijs✓L �� f I IOWNER'SNAME t, JOBSITE ADDRESS G OWNER ADDRESS f ARAUJO CLAUDINE M 57 KENCOMSETT CIR YARMOUTH PORT MA 02675 I TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT PLANS SUBMITTED: YES 0 NO 0 CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 FIXTURES • BOILER . BOOSTER CONVERSION BURNER COOK STOVE . DIRECT VENT HEATER DRYER . _FIREPLACE FRYOLATOR FURNACE 1 GENERATOR . GRILLE INFRARED HEATER LABORATORY COCKS , MAKEUP AIR UNIT . OVEN POOL HEATER . ROOM 1 SPACE HEATER , ROOF TOP UNIT . TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liabilit 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 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 (Stephen Winslow I LICENSE# 112298 I SIGNATURE MP© MGF ❑ JP❑ JGF 0 LPGI 0 CORPORATION 0#I I PARTNERSHIP 0#I ILLC El#I I I COMPANY NAME: ISTEPHEN A WINSLOW J ADDRESS. 18 REARDON CIR, I CITY S YARMOUTH STATE IMA I ZIP 026641207 TEL I I FAX CELL 1 1 EMAIL Iinspections@efwinslow.com I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# PLAN REVIEW NOTES r M. _ MASSACHUSETTS UNIF ORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK PERMIT # �-� 21—ov�o�3 ' =:yam __...__ MA DATE11121 5 =ti = CITY YARMOUTH z. . - yam.. _ ESS 347 GREAT ISLAND ROAD, WEST YARMOU� OWNER'S NAME ROBERT GRIFFIN JOBSITE ADDR A ." .,.... . .......�. TEL 50$.534.9147 GOWNER ADDRESS ` 2 JUSTIN COURT, PALISADES, NY 1096 EDUCATIONAL RESIDENTIAL � TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT PLANS SUBMITTED: YES NO CLEARLY NEW:I�_.._..' RENOVATION: REPLACEMENT: � 2 3 4 5 6 7 8 9 10 11 12 13 14 APPLIANCES Z FLOORS—' BSM 1 ������ BOILER ��� -� -- BOOSTER MI ----� — CONVERSION BURNER — �� ���� --__ all COOK STOVE _-- —_ 11111111111 DIRECT VENT HEATER IIIIIIIIIIII ---���� DRYER —_----__ 111111 FIREPLACE �� FRYOLATOR —�_ -_ �_--- III__ FURNACE ��_ _—� ��� l GENERATOR � ���_� GRILLE --__—_ 11 HEATER —_—_—_ � �-_ Mill () INFRARED —_--- ® NMI t/� LABORATORY COCKS --�—�_�_ MAKEUP AIR UNIT --IIIIII ---- -- OVEN �������— POOL HEATER— --__—__ HEATER _---- � �� l ROOM 1 SPACE ��� �_ _- cr ROOF TOP UNIT ��� -_-10111 _--�- UNIT HEATER 1111111 �� — � —_ UNVENTED MN ROOM HEATER —_ — N _—_---__ ���� WATER HEATER OTHER ........_ ....__..._....__.... _...._.__..__..._._ ��� - � _. -� ------_ Mill - MI :,. .w , ..; INSURANCE COVERAGE substantial equivalent which meets the requirements of MGL. Ch. 142 YES t NO I have a current Ilabili insurance policy or its q HE APPROPRIATE BOX BELOW I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING T BOND LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY OWNER'S INSURANCE WAIVER: I am aware th at 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 ET: AGENT SIGNATURE OF OWNER OR AGENT application are true and accurat to the b st of my knowledge this willbe in re true an a P rtihe provision the I hereby certify that all of the details and information I have submitted or entered regarding in work and installations performed under the permit issued for this application ,•►0 0n and that all plumbing Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� _LICENSE # 12298 SIGNATURE ' PLUMBER-GASFITTER NAME[STEPHEN WINSLOW L LLC , #f ,, PARTNERSHIP La� #: �� - - JP . �' GI CORPORATION # 3281 C MP MGF JGF LP ._ --- COMPANY I Y NAME:= E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CI COMPAN �--�~-- �TEL 508-394-7778„_, STATE MA ZIP 02664 __ , CITY SOUTH YARMOUTH :_ ____..._.____.___._.._.__...._.._..._....__........ . ....._....... INSLOW CO 8-394-8256 , CELL NIA EMAIL INSPECTIONS@EFW FAX 50 ___. ...._.�...r. ..�_...