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Home My WebLink AboutBLDG-23-001503 L',\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �,� 1(�(� CITY YARMOUTH MA DATE September 21,202 PERMIT# BLDG 23 001503 uu=l. JOBSITE ADDRESS 118 DRIFTWOOD LN OWNER'S NAME Jane Auder G OWNER ADDRESS 118 DRIFTWOOD LANE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL Li 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 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride a(�0mail.com S31ON M31A3M NVId #1IW213d $:333 ❑ ❑ 111NN3d 3H1 SV S3A213S N011VOIlddV SIH1 oN saA S310N N01103dSNI AINO 3Sf1 210103dSNI 210H 30Vd SIH1 S310N NO1103dSNl SVD Her101 w MASSACHUSETTS UNIFORM APPLICATION FOR A P MIT TO PERFORM GAS FITTING WORK .' ` L,/ r4 ,_ ' CET( MA DATE SO - ��=- , 7 / 7/z.2___ PERMIT # Z3 - iSo3 JOeSfTE ADDRESS '"!1 I � I0 � t OWNER'S NAME\...1 czAq 8-----ufeeet-- G OWNER 313,�DDRES ci /'C/J � T'"� TEL 6 ?5 FAX TYPE OR z PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL. ❑ _DUCA I IONAL U RESIDENTIAL P CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES 11 NO [I( APPLIANCES �l FLOOR-f BSlyl 1 2 3 4 5 6 o BOILER 10 l•l 12 13 14 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE --- FP,YCiLATOR —� _ l FURNACE GENERATOR GRILLE1 J INFRARED HEATER — -' ECEIVED LABORATORY COCKS MAKEUP AIR UNIT OVEN S`Ov 26 POOL HEATER ROOM ; SPACE HEATER `____, ROOF TOP UNIT - FtUILDING DE PARTVIENT TEST E3 y — --- - , 5T ` / - -UNIT HEATER . . _.... [INVENTED ROOM HEATER -- WATER HEATER OTHER ._� i � I I INSURANCE COVERAGE I 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 [}' OTHER TYPE INDEMNITY ❑ BOND • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required byChapter 142 Massachusetts General Laws, and that mysignature on this permit application waives this requirement. ent. of the Massachusetts General SIGNATURE OF OWNER OR, ENT AG CHECK ONE ONLY: OWNER ❑ AGENT El,7�, .1_ 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 m k and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Perti Y nent pro�lision of t l-�noh edge passachusctts State Plumbing Code and Chapter •1�42 of the General Laws. e Massachusetts fac/iLti M. C,PLUMEER-rASFIT ER NAME 3 C 1 LICENSE # SIGNATURE MP ❑ MGF ❑ JP UP JGF ❑ LPG! n CORPORATION ❑ 41 pop PARTNERS�H P I0 # LLC COMPANY NAME j\kj- ri ,i/ p. ADDRESS rtqltr--1/ 1 A--c-"e CITY l' n I STATE44 ZIP 6 d TEL 1 ? ' 1. ./.,d 2',/ Z-Z..., FAX CELL EMAIL < /1 ) , 404. Cif 2 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES '(es No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: v PERMIT# PLAN REVIEW NOTES