Loading...
HomeMy WebLinkAboutBLDG-22-001830 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK --7E-..k e CITY YARMOUTH MA DATE September 30,202 PERMIT# BLDG 22-001830 JOBSITE ADDRESS 24 ELMCROFT WAY OWNER'S NAME GAVIN STEPHEN L TRS G OWNER ADDRESS GAVIN ANNMARIE D TRS 24 ELMCROFT WAY YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 2 - - 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 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 El BOND El 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 El MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(a efwinslow.com S310N M3IA321 NVId #111N213d $:33d ❑ 0 AMU 3H1 SV S3AN3S NOIlV0IlddV SIHI oN so), S310N N01103dSNI 1VN1 1 AlN0 3Sf1 N0133dSNI NOd 39Vd SIN. S310N N01103dSNI SVO HOf1021 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK :t. 'TETI I tliw CITY YARMOUTH i MA DATE a•9/28/21 .--..-„„.a..„..-..„.: PERMIT # 22— 15 d JOBSITE ADDRESS 24 ELMCROFT WAY, YARMOUTHPORT OWNER'S NAME STEVE GAVIN GOWNER ADDRESS SAME I TEL 508362.4854 JFAXI---1 TYPE OR .-.>- PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL . I RESIDENTIAL CLEARLY , - NEW: RENOVATION. REPLACEMENT. ' PLANS SUBMITTED: YES 4 NO APPLIANCES - FLOORS-0 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 2 GENERATOR GRILLE INFRARED HEATER —:,,. . LABORATORY COCKS MAKEUP AIR UNIT { OVEN i POOL HEATER _ ROOM / SPACE HEATER , ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER :,.,,.,..„_<*,> e«mwwn:Nnav,uwav«m mtww«sx ,,„„ava_aaawmv. ww___a„m:.,nm,_oww .,__�,,t,,,,• nay.•'.•, _„„„„,,, .,,,,„,—,.c•.•. ;<u f _:...�•..,, ..n,.„aexex,�axcx�.a::.�:.,z..w,.,,..wac, •. _ : ... ::. v.�. ,._::_ -_. _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 ..J SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted cr 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 Laws. ` mm .0111.1440/••••••...... PLUMBER-GASFITTER NAME i, STEPHEN WINSLOW LICENSE #$ 12298 I SIGNATURE MP MGF JP JGF gin' LPG! I , CORPORATION � # 3281C PARTNERSHIP �� #; LLC s,„ # COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH � STATE MA ZIP 02664 1TEL 508.394 7778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM