HomeMy WebLinkAboutBLDG-22-003415 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
" CITY YARMOUTH MA DATE 'December 15,2021 PERMIT# BLDG-22-003415
JOBSITE ADDRESS 170 OUT OF BOUNDS DR I OWNERS NAME Howard Levy
G OWNER ADDRESS TELI
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El
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 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 0
IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY 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 al the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME LESTER WADE LICENSE# 4569 SIGNATURE
MP❑MGF Q JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑#
COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,
CITY COTUIT STATE MA ZIP 026352702 TEL
FAX CELL EMAIL
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,0, ifi,-,SSACHUSE T TS UiN.IFORM APPLICATION FOR A PERMIT TO PERFORIVJ GAS FITTING WORK
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JOBSITE ADDRESS i� ► ?L j� t � at 5 .i - OW1;lER S NAME -v / �y j�t / �. c /C CC� !(,i �. � 1 1 )f`. l� � � ' ' f' �' � r wC.�f �L l. V � //i-ccc. -ei
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�ii OWNER ADDRESS S ,c�- coo 0 V e, I TEL -:,)i 7�4 $ t - `L{I{a-% FAX
�t ,..�,TIT 11, OR
OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL IONAL _ RESIDENTIAL Iv,'
• NEW:13Z1 RENOVATION: ! 1 REPLACEMENT. Li PLANS SUBMITTED: YES 7 NO
APPLIANCES 1. FLOORS-S 1 BSI,1 ! t j 2 3 ' 4 5 1 8 1 7 i 8 1 9 10 ' 11 I 12 13 14
BOILER ..-------1, --11- ._._-__'i -1
1 _ i if li-----------F.---f--t-----'' ,, ----—r." .._.Y ---
^CONVERSION BURNER '------ i1----- 1,1 -- r- ;�---.,�---`i[ L_4L Jy ` ` _ `1 ��. 1r _COOKSi0VE ... -- ,�_ ,
if ,i 1) ,• :1 '11 11 _-.'% l' !`- :1__ii :1_,,
DIRECT VENT HEATER f�- ( [--�—'i ---�; F=—�i �r ___v` ;1` iC--'
, DRYER ill
:F-7:I :, „
., t :1-----17-il c
FIREPLACE 1�. ' __=fI}__�.1: 1►— I �i1 = i, — ' . � d ,
FRYOLA.TOR i . -Li ' .. . it .r __ ,_� _11. _ - 1 . - - it— �`t
FURNACE 11 __ If -'1. __. ___ .,r '_ IL II 111. I!�:;__ . a_ _ ' 11__ ..._.11_. _=;
GENERATOR ` .1
_._.�1}. . t, .:I, L= =1— h l' _w. '_._. ..__ i �_ _ —_ 1 .--
____ :,
GRILLE L a��:4_-i 7----`' �r-`---ii --y�(- c t n
INFRARED HEATER Ii — ' =:I i ; =i1.
��l ?1 :! -__ ''-'1 .r_ .
LABORATORY COCKS L - .T-- 71_ ' 'r i `
MAKEUP AIR UNIT :'. —
POOL HEATER F :i --- 1� __ ... Ti _ . - w ,� —, �!f �--'__._._;,_ — 1 _r
.� r :_
j , .r I. .;
R001vj / SPACE HEATER !; ?i ~0 . ;; ' LT—11 I! ' _�. ._ + _
ROOF TOP UNIT ��—; - - t___-,1 {� -i- (_—;:
L _il. . , 11 _ _ f ____JL _- . .__,_ -- -.. , .•._- z�_.�...�.___-
TEST ii_ ,; . ..�._.1I _ ..;: fi j ..�:'' f i ji 0 ._.. 1 ��.L._
UNIT HEATER 'C" ' ---;!---1 a 'ii ;...-- '; 1 „-
UNVEh UNVENTED ROOM HEATER [ (` _ 7 rf-- - 1 a�--- - -__1 Ia y `
WATER HEATER 1� r� 0 i ,: li 11 ii !,
•
OTHER 4[�+1 .. .�. _..-' � l L,_ ._ . ! _...__. JL
L.__ F-11 11 ;:i !,1; 7----ir--11--- ir-----7---,17—..,,
L INSURANCE COVERAGE
I have a can&nt liability insurance policy or its substantial equivvalent +which meets the requirements or iMi1GL. Ch. .142 YES {-II10
l iF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BO;: BELOW
LIABILITY INSURANCE POLICY ✓� OTHER TYPE INDEMI T•,' I 11 BOND
OWJER'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 sic}nature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER I 1 AGENT 7
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 ail plumbing work and instaiiations performed under the permit issued for this application will be in co pliance with all Pe anent ovision of the
ivlessachusetis State Plumbing Code and Chapter 142 of the General Laws46. ,
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PLUMBER-GASH T TER NAME I Le S4cr- Lc'et_Et& i LICENSE Tl 4510 cf SIGNATURE
MP iviGF ,Or JP pi JGF fl LPGI 7----- CORPORATION1l# _ PARTNERSHIP 1__ # I LLC Url
COMPANY NAME: `'" .e Cccf D.;_ei:�.�)e, lc 4'4+ �'liu&00RESS i "2 3 O�,4L:ct cti, �.1 -
CITY lUtkl 51,t. p e. t_ STATE ! M14 I ZIP 7;2.L.' ti1 1TEL 150 .c;{7?- tie- 'S-• I
FAX } 10ELL1 - 5V - EMAIL iNk-r (L., (-L. � p G;e.v Lei`z::-40 4- ; • CC ►'rl