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HomeMy WebLinkAboutBLDG-23-005581 k , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE April 07,2023 PERMIT# BLDG-23-005581 JOBSITE ADDRESS 31 POWERS LN OWNERS NAME BOARDWALK LIGHT LLC G OWNER ADDRESS 11 RED TAIL RUN CANTON MA 02021-1685 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El • 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 1 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 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 Douglas Langtry LICENSE# 11305 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: AQUA SERVICES ADDRESS. 1200 Route 28,1268 ROUTE 28 CITY South Yarmouth STATE MA ZIP 02664 TEL 5086193367 FAX CELL EMAIL doug-aguacomcast.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ �, YARMOUTH 4/6/2023 / MIT #�'��' .° 7.3- OOSSV a r :o CITY,,,, PER MA DATE JOBSITE ADDRESS 31 POWERS LANE SPADEA OWNER'S NAME GOWNER ADDRESS TEL 781-718-3001 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL ■❑ PRINT CLEARLY NEW: ❑■ RENOVATION: ❑ REPLACEMENT: n PLANS SUBMITTED: YES ❑ NO 0 APPLIANCES 1 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 1 INFRARED HEATER LABORATORY COCKS t .....— ---\ MAKEUP AIR UNITRECEIVE -? OVEN POOL HEATER _ ROOM / SPACE HEATER • APR 0-6- 2823 ROOF TOP UNIT -. TEST g 1LD�N� U ARTMLNT 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 ■❑ NO n 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 by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER n AGENT n 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 o t e 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 ''ert. ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' ---- /11 t/ 4 PLUMBER-GASFITTER NAME DOUG LANGTRY LICENSE # 11305 r / IG i 'TURE MP I. MGF n JP JGF 7 LPGI CORPORATION # PARTNERSHIP # LLC ■ # 3081 COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28 CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367 FAX 508-619-3367 CELL EMAIL DOUG-AQUA@COMCAST.NET ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES