Loading...
HomeMy WebLinkAboutBLDG-21-007212 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ”1 + j6 CITY YARMOUTH MA DATE June 11,2021 PERMIT# BLDG-21-007212 JOBSITE ADDRESS 222 PAWKANNAWKUT DR OWNERS NAME (bernard mcfarland G OWNER ADDRESS MA 02186 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ 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 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 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑ COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbrideagmail.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 P i MIT TO PERFORM GAS FITTING WORK I ti iv -:E ,e- C€T`( MA DATE P�-tM IT r 04CISh4ri (k)1/6* JOBSITE ADDRESS _ vL1 Jibe v h�i�IER �lME � � �Lc v G OWNER ADDRES A d 7 6416 TELas ` 7 /' FAX TYPE OR ti&1 P_ PRINT OCCUPANCY TYPE COMMERC1 ,_ EDUCATIONAL 7 RESIDENTIAL NEW FT ,RENOVATIc t_ : .: t fi �� NI-: 7 PL N U n ED. ��ES ❑ NO APPLIANCES • FLOORS-I BSM 1 2 3_ 4 5 6 7 8 9 10 'I'I 1 2 'I 3 1! BOILER BOOSTER ________I CONVERSION BURNER 1 COOK STOVE DIRECT VENT HEATER DRYER l FIREPLACE j FRYOLATOR FURNACE ' / . 1 GENERATOR. GRILLE INFRARED HEATER LABORATORY COCKS I MAKEUP AIR UNIT OVEN i POOL HEATER ROC)M / SPACE HEATER ROC)F TOP UNIT TEST _ . . .__ . . . . . .. .. . .._. . . -- • --._ , UNIT HEATER UNVENTED ROOM HEATER ___I___- WATER HEATER OTHER l , _ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES n NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY [1 BOND• OWNER'S INSURANCE WAIVER: I any aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 t Massachusetts General Laws, and that my signature on this permit application waives this requirement. i �'� CHECK ONE ONLY: OWNER n AGENT ❑ 1 •- SIGNATURE OF OWNER OR AGENT y I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the `J p 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. ! `U PLUMBER-GASFITTER NAME LICENSE # SIGNATURE MP E MGF ❑ JP ❑ JGF ❑ LPGI 7 CORPORATION ❑ 4 PARTNERSHIP E # LLC COMPANY NAME ADDRESS CITY STATE ZIP TEL 1 FAX CELL EMAIL r r + 1 1 1 G1rzzl G. 4 i Pit I � RA Z. I I I I I I I I 7" 1 CA to IA at E-1 . cr.') Crt ft a 14 > w L FA co c9 o, P I GJ U I C EL. < tip' Gfy Ii i 1 S tU �� Oy I 1 co I W' { V. 1 � t I rzi i up 1 `i' 1c,, I 1 ® M 1 1 i I •