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HomeMy WebLinkAboutBLDG-22-002894 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 18,202'PERMIT# BLDG-22-002894 JOBSITE ADDRESS 26 COTTONWOOD ST OWNERS NAME Tom Bache G OWNER ADDRESS YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 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 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 1 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 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 wit he in compliance with at 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 0 JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC El# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS, 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride(o,gmail.com — w S310N M3IAR1 Mild #IIW2j3d $:33d ❑ ❑ 1IVJ 3d 3H1 SV S3AH3S NOLLVOIlddd SIHJ oN saA S310N N01103dSNl 1VNH AINO 3Sf1?JO103dSNI elOd OVd SIHl S310N NO1103dSNI WO HJf1O2I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Itl S 0 ii_I-!' CITY T (�1J4- — MA DATE' /r54r1PElT# JOBSITE ADDRESS' .1 (-:-. --14 /1 wOQ_04^ I OWNER'S NAME�/�— 4 1 G OWNER ADDRESS _ ---- -"7--- ,-- T . (TEL- �� FAX f TYPE OR OCCUPANCY TYPE COMMERCIALCOMMERCIAL._1. EDUCATIONAL J RESIDENTIAL', ' PRINT CLEARLY NEW:..._1 RENOVATION:J REPLACEMENT:)SI PLANS SUBMITTED: YES EJ NO V APPLIANCES 1 FLOORS-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _J_:_-_J____r-J_J_1• _ __J__ I I J_____J_____I__-__1__I BOOSTER .I I, I t __Ili__ J _1,._i C_I I I CONVERSION BURNER 1_ i ( } i_1: I. 1 I I_J_.1 I COOK STOVE ._ tom' I_L ' -- t l: J_-f _I J !_J DIRECT VENT HEATER ____IJ__ J____I_.J =I- _ Ir_I -_-______I'____I - ____I -��. -.. . .I t_ ._ ..I �� f 1 (_J I I - FIREPLACE _I J_• J^: J_J __1-J I .. I . I _.._-I__I �_ I FRYOLATOR I-1-1-�._ t� ... _.I. ._ I, i _ I __I —J__-_I J—J .` J FURNACE 1—J I I ,- I i I j_j_i_i '_i_i---j ----I I GENERATOR I_J i I_�__I____j ____J __I,__J I__J I GRILLE __i l -_1 I -I__I.-J _. __I ______I.__....1 -J INFRARED HEATER ___I I__I _I 1---..i-('-� i _ J-J ______J LABORATORY COCKS ,___I - _ 1___j 1, ___I_J I_. __J I-.__I_._.J___I I_J_J itMAKEUP AIR UNIT I 1,'___.1__J__J I_-___-I _J I .-.J__i-.J . _J_J OVEN I 1 ; I I ____.._1___._J I __I_ I,...�._I___J--_.I ____I i kb POOL HEATER __.J___ i._._J_�,_ !�.J ;_____J,_I,_J I . .i___J__,J-J ROOM!SPACE HEATER ___I . I I I I __I f I i I _I I ROOF TOP UNIT _.__._I i r I i . - I - I I-- I I I TEST I i I i__ ; I i I i ___ I I UNIT HEATER I_J _ I i ( -.I.. UNVENTED ROOM HEATER __j-J ? i i� ,_J __I_ _I__I J i _- WATER HEATER ._-_-___ --- - / I l. _ €- I !' ! J�_J I I ---I I I OTHER —..I I: -1• 1 I_I 1 1____.J-J-J'_-1 J I _II-1._-__I _ i _ 1 - . _i . I - I !J_'_ _Li -J L. I ._ 1-I---I__ ___1 ` I !_._..!-J__J_-j 1-J U ---I -i. 1 1 1 I . I I I I l J _ ! i INSURANCE COVERAGE _ _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES i NO J 4. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY IC OTHER TYPE INDEMNITY � BOND l_i 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 mpliaoith all P`in�provision of the, Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �n( J ....� PLUMBER-GASFITTER NAME Y ` /'/ f k L�q{t°L 1 LICENSE#77 i —SIGNATURE - MP MGF tJ JP JGF LPG' _J CORPORATION: #` 1 PARTNERSHIP:!# LLC J# COMPANY NAME. - - -} -- p-i-i-1- -- - -- �f� ' ,,p- I ADDRESS / i� ,, - ... - CITY / GI n ✓I/ .5 I STATE•AP ZIP o� O7TEL 7 7 y 77, --7-7-C , FAX I CELL !EMAIL 5/--1 n5 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 1 li,t101._1.11 • e"`. •