Loading...
HomeMy WebLinkAboutBLDG-23-000763 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK /re CITY 'YARMOUTH I MA DATE 'August 15,2022 I PERMIT# BLDG-23-000763 JOBSITE ADDRESS 130 ASTOR WAY I OWNER'S NAME Christine Slack G OWNER ADDRESS 30 ASTOR WAY SOUTH YARMOUTH MA 02664 1 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT',0 PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BOILER BOOSTER • CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER • FIREPLACE FRYOLATOR FURNACE 1 _ 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 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL I I EMAIL halloilcompany(a.gmail.com S310N M3IA32:1 NVld #JI1A1d3d $ :33d ❑ ❑ IIV d 3H1 SV SAS NOLLVOIldd`d SIHI oN saA S310N N01103dSNI 1VNId AlN0 3Sf1?,10103dSNI 210d 39Vd SIHl S310N N01103dSNI SVO HJf102J # ,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =`= =Y CITY [-_-:" . y..„...,„:444,„____,,- MA DATE $� a "t•,:=,�' •� . a PERMIT # JOBSITE ADDRESSL30_i9 nr C.3 a I OWNER`S NAME G OWNER ADDRESS ' `' i ----- TEL.7�-; -3zsv fFAx[ -- PRINT TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCA NAL fl RESIDENTIAL CI--- CLEARLY ----- NEW: RENOVATION: [1 REPLACEMENT: 1,_ _ PLANS SUBMITTED: YESD NO( APPLIANCES Z FLOORS--► 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOOSTER ram: � I .� = : :- � .� - .. � of £ I. ,� 1{ - s j � ._._ _:.:� .v. yw_ Li�w r • . �y.:FK•4�t��Wv�_...r��♦ -- •r�.w.-c r �:�.}u. CONVERSION BURNER - g _j�-_ .• �.�,^ ~r_ i N.. 1 ---� COOK STOVE - _ .:.r s - + - - i �— DIRECT VENT HEATER r - .. � _ _ ._ ,I -_ _ -._� DRYER _ e _ yet' , _ I_ (} FIREPLACE ==- �_ .-, q �.�: ,:� �_t _L ; _ _. i ;.!7 ITS "'..x.- .....�.-w ,...ems:.... _;m.n,.,.r..n, .._,...-.... .v_...-,.a,. FRYOLATOR ._ f �,_�, - .�, w I,1�`— .. FURNACE I �� ;I -, - : c :,: - �.=��._ ��� : -� �_ GENERATOR ------- ;_— - __-•_ _ -- _ __ - .._ _ __-- i' GRILLE y= =r — ° __ :{ __ ri.: - ::�.. INFRARED HEATER fix" ----•`� --'1._ i J _-� 4� .. mix � � �- ! �� -- . } .: - _ 1 LABORATORY COCKS a � _. �. ., MAKEUP AIR UNIT — _ ...... OVEN POOL HEATER r- —f; __ = :•:=y:� ___- .- _^ .�__ ROOM 1 SPACE HEATER -__ —�1, f _ N1+ �- ; — � _ rl � ,� _.. .� _ ROOF TOP UNIT _ -- __ � — 1' -:. - �.r--_._ --- _ Jr :tiz ., ., , ...r:----.`r_,_.. �. TEST � , s- r_ ___ _ .� # tr u yf r. rF _____ ..... -•. f' _Y-- "_1.'.�:. +n;.=._:a.::c,:, tom•. ._.. -l.J,:'n�>d :•�` . j lc______. - .:�,...i1. _ *_-..•e-wav ac�,v.' ..I �_�� �f.r,...Y •^ �I UNIT HEATER 1 - _ i. �r..._ ._... i�`'�''--.'-- f(_ _ rGd {:(�.5•_S: =.S_."r. _fk � —..... UNVENTED ROOM HEATER - ,-= _ _ _ WATER HEATER i— t E - - I OTHER .. . ` . - _ ��. — �: �_... _ L:� �,._ r .. ? ,� _ _, �_. _.„ Imo.r_z�.:,-- ,_ .: , -_,? � -. � 1 :.- .� —lif " y..�.-,..� �u.:�t,ll a. r .�-•......,...-.. �K.�. ..r�y'�sri�^ --.. .11•._��,.�-�i':.=-�. ...:.-,.:.�` .+1�.--u.• -.�.I�.�car�Q. ,...-...v-{ .L J „ w.w+' 1. W-_f —_ is fl -'-- -- ' ��- , • �-r �.�„ -..,.f...... �-.y...,..:., y. �r+sc„_._ .r—,� ......._�..... .- �-,��.✓ 1r+ .�.r=�> ::=a' .c_:ur�-:•r-s� .:..+u-w- :.�.,�.,- i .ala,,.._ - 1 r-sw.v,-... y..., INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO El I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ri I OTHER TYPE INDEMNITY 1-1BOND L ., 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 .� AGENT Li SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this appiicati are land curs to theVest of my knowledge and that ail plumbing work and installations performed under the permit issued for this application will e in compTianc with Perlin, t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / • J- PLUMBER-GASFITTER NAME si/? Nib X j G-�° LICENSE #rt SIGNATURE i iP MGF L. JP ri __,:j JGF i LPGI rj CORPORATION #Lv.,,,,._ei PARTNERSHIP[. 1# � v _ LLc 0#F.__ ___ .1 COMPANY NAMELZ 4_, Oft- CO . 7/yc- ADDRESS.. __ 3. CITY �� - J .S s STATE L19ZIPQ�� � TEL ��t �. FAX E- 0ir CELL �.. .. . ..:__.._�.�. EMAIt.It ' �l�-f/ Oe• !_('JJ c l�f,�/�.� �-a -7 I r...IiG2L._ r+.,..._.�..�. _..r--_.G1Y:a.aY�:Ce.�:J'Y. a..a•--4 t e01,- .. ;