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Home My WebLink AboutBLDG-22-000244 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �' CITY YARMOUTH MA DATE July 14,2021 _PERMIT# BLDG-22-000244 IE=Ilt. l W JOBSITE ADDRESS 31 PEBBLE BEACH WAY OWNER'S NAME SULLIVAN KELLY A TRS G OWNER ADDRESS SULLIVAN LORI A TRS P 0 BOX 353 SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0 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 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER , ROOM/SPACE HEATER ROOF TOP UNIT , TEST 1 , 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 0 OTHER OF INDEMNITY 0 BOND 0 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 0 MGF 0 JP❑ JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride a,gmail.com S310N M3IA38 NVId #LIW2l3d $ 33d ❑ ❑ 1I1,1213d 3H1 SV S3AHRS NOI1VOIlddV SIH1 oN so), S31ON NOII33dSNI 1VNId AlNO 3Sf180133dSNI 80d 30Vd SIH1 S31ON N01133dSNI SV0 H0f102i �__ MASSAC✓HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK il `' CITY Al_�, , !Lr / MA DATE • PERMIT *. R t �C E I V ITD DRESS 3/tPP 64-,, e2j e 7 c 6 LA.. .1-9/ OWNER'S NAMEE/qic- kIEARESS TE .it 4 2�� 1 �� 2.b/ E=Ay OCCUP NC"Y TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL, Btpt.ix I RPIARTMENT By. - NEW: - RENOVATION: ❑ REPLACEMENT:, ( 7)I- 1' PLANS SUBMITTED: YES ❑ NM .APPLIANCES 1 FLOORS--+ BEM 1 2 3 4 5 6 7 8 9 10 11 12 1J BOILER BOOSTER Ild , . CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR. 111 -1-1 -1-1-1-1 ----1111111111111-1HI GRILLEINFRARED HEATERLABORATORY COCKS MAKEUP AIR UNIT OVEN _____Ii 11.30 I POOL HE;,TER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER j l OTHER INSURANCE COVERAGE I have a current Liability insurance policy or its substantial equivalent which meets the requirements of NICL. Ch. 142 YES ENO n IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY FI BOND ❑ OWNER'S INSURANCE WAIVER: I any aware that the licensee does not have the insurance coverage required by Chapter 142 of the i Massachusetts General laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ • 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 a I Pertinent provision of the Massachusetts State Plumbing Code and Chapter .142 of the General Laws. ,.,,.3 j) c ____) ,... _ PLUMBER-GASFITTER NAME f " Cla rt C LICENSE # SIGNATU RE MP ❑ MC4F _ JP it JGF n LPG! CORPORATION ❑ # PA.PTNERSHIP [] # % LLC ❑ : COMPANY NAME oi, &) riSQ P ADDRESS 9 V (C (, 64.0 f CITY �( rk 100 Fil STATE ZIP 2 (4, 7 TEL)! O z a FAX CELL. EMAIL 31---1 /2, 0-1-N-r ."CZ 1, cJ 0- 0"--1 L ' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL II<JSPEGTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES