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HomeMy WebLinkAboutBLDG-22-006829 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE IMay 24,2022 I PERMIT# BLDG-22-006829 JOBSITE ADDRESS 118 ANTHONY RD I OWNERS NAME Vicki Evans G OWNER ADDRESS 18 ANTHONY RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 LABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 BOND ❑ OWNERS 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 LESTER WADE LICENSE# 4569 SIGNATURE MP 0 MGF Q JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑#F LLC❑# COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY COTUIT STATE MA ZIP 026352702 TEL FAX CELL EMAIL infotccipgenerators.com S310N M3IA2 i Ndld #1IW213d $ :33d ❑ ❑ !Mad 3E11 SV S3A213S NOI1V3Ilddb SIHl oN saA S310N NO1103dSNI 1VNH NINO 3Sfl 80103dSNI 8Od 39Vd SIHI S310N NOI103dSNI SHO HOflO I • MASSACHUSEfTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK __ - ~ CITY Q't'fvl'©lt-f' 1 MA DATE 3—q PERMiT# 2-2-(0?25 JOBSITE ADDRESS J4'1441 to pt OWNER'S NAME V t G1(.1 C V et-vI S S CL t1-)C�V . TEL 1�`�- 3���3� FAX G OWNER ADDRESS I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PLUM CLEARLY 'NEW:g RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMI i I EL): YES❑ NO l APPLIANCES I FLOORS BSM 1 2 S 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE T'— FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY.COCKS MAKEUP AIR UNIT OVEN POOL HEATER ,1111111111111.11711111.1111111. ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabiIiity insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES g 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 ❑ SIGNATURE OF OWNER OR AGENT I hereby certify thatall of the details and information I have submitted or entered regarding this application are true and accurate to the best of knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance ' all P t " onof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C�G� PLUMBER-GASFITTER NAME L -'-F e.rr ir)a ete- LICENSE# 4 5(0 q s RE MP❑ MGF® JP[] JGF❑ LPG)D CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Cap e_C.d cf� d,�Q. �� At t;.L r ADDRESS a-3 Bov.;ele CITY Oka.5k -e STATE MA ZIP 49 -(10 ii TEL 60V-4/1—€g 1 FAK tokA CELL 50S-150— a EMAIL OD �.c.i cer� e�:-f-ars. tr: virt