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Home My WebLink AboutBLDG-22-003679 #11A I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ern �' BLDG 22-003679 e � CITY YARMOUTH MA DATE January 03,2022 PERMIT# JOBSITE ADDRESS 11A&11B MERCURY DR OWNER'S NAME THE STRAWBERRY LIMITED PARTNERSHIP G OWNER ADDRESS 1645 NEWTOWN RD COTUIT MA 02635 TEL _ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 1 DRYER FIREPLACE FRYOLATOR FURNACE 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 El 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 Chris Poire LICENSE# 33901 SIGNATURE MP 0 MGF 0 JP❑ JGF 0 LPG! 0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: ADDRESS. 37 Calvin Drive, CITY Dennis STATE Ma ZIP 02638 TEL FAX CELL 7748366461 EMAIL mcplumber ,pmail.com S31ON MIAMalAR NVId #1IW213d $:33d ❑ ❑ 111N213d 3H1 SV SSA83S NOI1VOIlddV SIH± oN SA S310N NO1103dSNI 1VNId ,llNO 3Sfl H0103dSNI 2lOd 30Vd SIHI S310N NO1103dSNI SV0 HOf O ,. __ .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 y w;�,-, --:,:lk_..--'6', CITY \t li" MA DATE PERMIT �► ZZ- 3 ro 7 `( JOESITE ADDRESS 1 f 0 inereury L t. NAME OWNER'S N. ,ME __ __iro yp , GOWNER ADDRESS TEL,22-g. eolui'f-- TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ElEDUCATIONAL 0RESIDENTIAL CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMEVr: C PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES FLOORS-+ BSIv1 1 2 3 4 5 6 7 o BOILER - _ 9 1 l 1? 1,3 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER / = DRYER, 1 FIREPLACE r-RYC?LATOR ` i RFp El E ®FURNACE —=-----____1 GENERATOR GRILLE JAN �3 2022 INFRARED HEATER - _ LABORATORY COCKSB.tE G i�t thifhR-CfdT 1 MAKEUP AIR UNIT B OVEN POOL HEATER ROOM l SPACE HEATER ROOF TOP UNIT r - TEST UNIT HEATER UNVENTED ROOM HEATER - WATER HEATER OTHER I 1 INSURANCE COVERAGE 1--- I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES t�0 ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAG - BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage Mas a - Netts General Laws, and that mysignature on this permit a t' ' es this requirement.u{red by Chapter 142 of the SI�N,�,TU . OF OWNER OR, AGENTCHECKONE ONLY: OWNER ❑ AGENT Fr 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 m kn and that all plumbing work and installations performed under the permit issued for this application will be in co liance with all Pertinen t prop i; y oh edgz Li J Massachusetts State Plumbing Code and Chapter 142 of the General Laws. sion of t e PLUMBER-GASFIT-CEF, NAME �� LICENSE # pl. 3 3 o SIG TURF MP E MGF D JP �Gr- -. ❑ LPG'GI ❑ CORPORATION E 4f PARTNERSHIP ❑ # LLC ❑ It. COMPANY NAME 0►r'e 1'4444 if i1-6 I Ccv4 g ADDRESS 3 7 adoi--- Dr- CITY Peliu S STATE /If4- ZIP a 2 6 )g TEL FAX CELL ) 2 Y Ef?i, 6 �G>/ EMAIL �G // br- ,LI e ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT tt FLAN REVIEW NOTES