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HomeMy WebLinkAboutBLDG-22-000018 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE July 01,2021 PERMIT# BLDG-22-000018 --,i1. JOBSITE ADDRESS 1 &3 ASPINET RD OWNER'S NAME WOLFE STEPHEN E TR G OWNER ADDRESS THE ONE&THREE ASPINET RLTY TRUST 370 RIVER ROAD ANDOVER MA 01810 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ 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 _ _ 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 _ 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(a)efwinslow.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 • • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH„ MA DATE 6/25/21 PERMIT # l - D( -ZZ - xC /6 . �. - . JOBSITE ADDRESS• 1 ASPINET ROAD, S. YARMOUTH OWNER'S NAME , STEPHEN WOLFE GOWNER ADDRESS ' 370 RIVER ROAD, ANDOVER TEL 508.759.8819 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL` EDUCATIONAL i RESIDENTIAL v CLEARLY NEW: RENOVATION: REPLACEMENT: ' a PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 vJ BOILER BOOSTER CONVERSION BURNER _ COOK STOVE _ DIRECT VENT HEATER _ DRYER • FIREPLACE , FRYOLATOR r3 FURNACE GENERATOR GRILLE . INFRARED HEATER V LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER T— ROOM / SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER ....._......... INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES v NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY '' 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 AGENT [,,M,,, 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 b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General L.aws. ` ? "` ,....oL- PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE #, 12298 SIGNATURE MP MGF JP JGF ` LPGI _ .. CORPORATION / # 3281C ! PARTNERSHIP # LLC # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE , CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-394-7778 FAX 508 394 8256 CELL! NIA 'EMAIL INSPECTIONS@EFWINSLOW COM