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HomeMy WebLinkAboutBLDG-22-004104 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH —1 MA DATE January 25.2022 PERMIT# BLDG-22-004104 JOBSITE ADDRESS 210 STATION AVE OWNER'S NAME DENNIS YARMTH REGIONAL SCHOOL G OWNER ADDRESS STATION AVENUE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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'he 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave. CITY WAREHAM STATE MA ZIP 025711324 TEL FAX 1 CELL EMAIL lisana coastalphc.com S310N M3IA32J NVId #11W213d $:33d ❑ ❑ 111*13d 3H1 SV S3A213S NOIlV31lddV SIHI ON SaA S31ON NO1133dSNI IVNId AINO 3Sfl 210103dSNI 2103 3OVd SIH1 S310N NO1133dSNI SVO HOfON MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e_. =,era l' �= CITY South Yarmouth MA DATE 01/19/2022 PERMIT # JOBSITE ADDRESS 210 Station Ave OWNER'S NAME Dennis Yarmouth Regional School I GOWNER ADDRESS 296 Station Ave - South Yarmouth, MA 02664 ITEL L FAX TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL 0 RESIDENTIAL L PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ' I PLANS SUBMITTED: YES NO❑ APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER , 1 � ��' _` _ _� - BOOSTER 1 � - --- CONVERSION BURNER COOK STOVE 1. ... E - = - DIRECT VENT HEATER DRYER ,ff . _ , _FIREPLACE �_-- �[ - .! - — l FRYOLATOR J _ `- 1 FURNACE 1=== _.,__. r il I GRILLE ----1 GENERATOR .. _. =,. _ — - INFRARED HEATER L ---;W , 11- -. ,. I 0 II 1 LABORATORY COCKS Li I I 11 1 MAKEUP AIR UNIT 1 Ell=[- 1, 11 , ._ . _ Ii OVEN _ . . I .1_4 11 iiii= !Milli Nil POOL HEATER 1 . _ .... ...I1 J_ _ - ROOM / SPACE HEATER J _, ii .,. ROOF TOP UNIT l r t _ . . tl, Il .0 1J I . I I TEST �( ! I I�_ II -I _ I UNIT HEATER fNEI UN UNVENTED ROOM HEATER '1�0 r 1_1_1 l _ 1 ( _ 1L.____.1L.J WATER HEATER i " OTHER . . ..._ . _ .____�__ i... ._I fi;�....,i.I.. I I_.�. I I . INSURANCE COVERAGE _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES P i NO I I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' i 1 OTHER TYPE INDEMNITY f1 BOND ''_1 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 I1 AGENT 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. r � /26 PLUMBER-GASF►TTER NAME Troy Gilbert 1 LICENSE # 13573 , SIGNATURE MP i MGF JP ❑ JGF❑ LPGI L] CORPORATION ❑#L.__ PARTNERSHIP❑#r , LLC Q# 4350 COMPANY NAME: Coastal Mechanical I ADDRESS 21 L Fruean Ave CITY l South Yarmouth I STATE MA IZIP 02664 TEL 508-737-8747 FAX 1 CELL 508-850-6955 EMAIL lisa@coastalphc.com