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HomeMy WebLinkAboutBLDG-23-004226 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t4 CITY YARMOUTH MA DATE January 31,2023 PERMIT# BLDG-23-004226 JOBSITE ADDRESS 15 PARK AVE OWNERS NAME LENZI ALBERT F G OWNER ADDRESS [ENZI JOAN M 216 CLARK RD LOWELL MA 01852 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ID 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE 1 GENERATOR • 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 1 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherineta7.coastalphc.com 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 i� -�,�— _-- 3— Li Z Z 6 '"Af,i CITY Yarmouth MA DATE 1/26/2023 PERMIT # Z JOBSITE ADDRESS 15 Park Ave OWNER'S NAME Michael Lenzi GOWNER ADDRESS 7 Brianna Way Dracut MA 01826 TEL FAX _, TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: 1-1 PLANS SUBMITTED: YES Lj NO I APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I BOOSTER ft L 1 .... 111111 11111111,M11111111111111 CONVERSION BURNER COOK STOVE - IS DIRECT VENT HEATER IL I� � �E� ,M1111111 _ DRYER FIREPLACE I r— FRYOLATOR FURNACE riiiiiiiiiii111111=111111111111111111110110111I GENERATOR GRILLE IMF Mill NM N INMI MIN INFRAREDM .11111 1111101111111111 ENINIMIN11111111111111111111111111111 MAKEUP AIR UNIT LABORATORY COCKS POOL HEATER 11 ROOM / SPACE HEATER 5,==== !!! ROOF TOP UNIT Elm MEW Nis MIME. NE MON 'Mlintimm. UNIT HEATER NM ME ME ME INN UNVENTED ••• MI N mum 7....girmosimmom WATER HEATER 111111MIMMTM NEM OTHER i111111111 fIl r `I•I I wpm. �ll�ll INN mai MINIM 111111111111111111111111111110111111111111111111111111111111111111111111111111111.1111111 Oil 0.1111111111111111 INSURANCE COVERAGE _ 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 j i 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 LI AGENT I 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. .. l2ditafileVt,t PLUMBER-GASFITTER NAME Troy Gilbert LICENSE # 135732 S ATURE MP MGF jj JP JGF ❑ LPGI Ej CORPORATION ❑# PARTNERSHIP„ # I LLC Ej# 4350 COMPANY NAME:Coastal Mechanical I ADDRESS 21L Fruean Ave r CITY IS. Yarmouth STATE MA I ZIP 02664 ITEL r508-737-8747 l FAX I CELL, EMAIL Katherine@Coastalphc.com