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Home My WebLink AboutBLDG-23-001600 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 27,202 PERMIT# BLDG-23-001600 ••�•`•• JOBSITE ADDRESS 126 PIERCE ST/5 E.C. I OWNERS NAME Lukes Liquor G OWNER ADDRESS MA TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: m 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 GENERATOR 1 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 0 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 ❑ 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 (Mark Watson I LICENSE# 3842 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IMARK D WATSON I ADDRESS. 181 CAPTAIN PERRY RD, CITY BREWSTER I STATE MA ZIP 026312559 TEL I FAX CELL I I EMAIL IDieman834comcast.net S310N MIAMalA3d Ndld #IIIN Jd $:33d ❑ ❑ 1I 1H d 3H1 SV S3A83S NOLLVOIlddV SIHI oN s8A S310N N01103dSNI 1VNl3 /11NO 3Sfl N0103dSNI 210d 3OVd SIHI S3ION NOI103dSNI SVO HOCION y A.8SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -,_ .CITY V3 Ya4 V U I 0 A-V\ MA DATE l — �Z PERMIT# 2,3-- /LG4 S i�BS E ADDRESS C> cc `�Q f� OWNER'S NAME la, GUILD UEPA OIM1ER?ADDRESS TEL FAY, ti , OR OCCUPANCY TYPE COMMERCIAL PRINT OCCUPANCY EDUCATIONAL ❑ RESIDENTIAL Q---- CLEARLY NEW:E' RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES E NO 0 APPLIANCES 1 FLOORS-4 BSM 1 2 3 1 5 6 7 8 9 10 11 12 1:i 1R BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 1 . DRYER _� FIREPLACE FRYOLATOR FURNACE GENERATOR 0 u - L4 I . 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 2 NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E 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 by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. J CHECK ONE ONLY: OWNER ElAGENT ❑ •� 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 a a urate o th est of my tnowiedge and that all plumbing work and installations performed under the permit Issued for this application will be In com a th all rti ter LW, Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C PLUMBER-GASFITT- NAME NI'A Klc D w K1s o ik) LICENSE#3 z{Z SIGNATURE MP ❑ MGF JP ❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP❑# LLC❑t# COMPANY NAME M�U S N E 1 t' ADDRESS Q( C / 1 f e r ll y (2--D CITY Aki,) S -e v' STATE M 11! ZIP 0 2-6 3 ( TEL 77Y--2-1 6 ' ( kl { (FAX CELL EMAIL(e Ma Vi 1 ,?c Cam 1. CQ S-T, s-Q lT ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL DISPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • • FEE: $ PERMIT# PLAN REVIEW NOTES • • •