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HomeMy WebLinkAboutBLDP&G-004443 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 05,2021 PERMIT# BLDP-21-004443 f JOBSITE ADDRESS 81 HEMEON DR OWNERS NAME BERTHIAUME CHERYL G OWNER ADDRESS GOULET THOMAS&DENISE 71 SANDRA DR WORCESTER MA 01604 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—I 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 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(cilefwinslow.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 1\ 'cm FfG CITY a t Lf-jn MA DATE /f 5 tZ I PERMIT#,�LIJ�21- 4 JOBSITE ADDRESS SS lernr.an )6 IJJ@5f Y/m.lk-in Q%G 15 OWNER'S NAME Ta (q IS2r1-41 i6i,im� 1 GOWNER ADDRESS -t ChM (c c�,r &Li K (J, 3 41nnwu cilwrw TEI�5OQ)$7' 5/a 7 FAXI 1 TYPE OR OC UPAN Y T PE COMMERCIALE- EDUCATIONAL 11 RESIDENTIAL -1' PRINT CLEARLY NEW:L_1 RENOVATION: REPLACEMENT: . PLANS SUBMITTED: YES UU NOL ' APPLIANCES 1 FLOORS-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER r I CONVERSION BURNER � __ COOK STOVE 1 _ DIRECT VENT HEATER I 1 1 ,h I 1 ' I 1 i I- I DRYER I I .__-I .. Y ( _ 1_-TM�� .1.. III_ i 1 g. ;J FIREPLACE __�( �. ,'-._._ �__-.v;,i�,�M_,/.�_ .�w.�.-,. �_, _ FRYOLATOR 1-- _ _ I�_ t • --- ___,....__II_ _1_____.r..- W ,1 FURNACE GENERATOR I — I y` , 9 I j I GRILLE I I I J.. l _ I ...- I __. I 1 1. I-.._.., INFRARED HEATER r_...� I _. 1_ I 1 ��iv •f- I_ - I LABORATORY COCKS I� 1 'I _ 1_ .. i __ ; I MAKEUP AIR UNIT i .Ts_..__ __. :. -- - ,r_-....:r__ 1 .u_ I I I I I OVEN I R I �_ 1� 1 I 1 1 a _ A R`._' I 5 POOL HEATER 1 ' I ROOM/SPACE HEATER 1—'1 11-- 1L- .1 , ROOF TOP UNIT 1-----_ I �. i__ _A4� i I I_ (�- TEST 7 -.._ �... �..-. 1__.._ .. �_. ,i. _. s [ ; . I UNIT HEATER h__��� _.. I I.� _ w . R_ .—_..i M1 . i I — + UNVENTED ROOM HEATER ,n--1 1___.y t qr_.:.. _ 1._ fi__ �1 r 1 WATER HEATER ._....... _ — --- 1T 1 -1_____OTHER i ' I 1 i - � i i v �. I I [ I �9 'i I i (.. _ I L. I . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E NO 171 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY r- BOND f I 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 El 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 accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a Pptine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C ` • !/Y .. -- PLUMBER-GASFITTER NAME I STEPHEN WINSLOW LICENSE# 12298 1 SIGNATURE MP Ell MGF El JP L-; JGF El LPGI f 1 CORPORATION El# 3281C 1 PARTNERSHIP1#i I•L-CC A 1 COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE ri' CITY SOUTH YARMOUTH I STATE) MA ZIP 02664 TEL 508-(394-7778 JAI1 2 8 2021 i. "'' FAX 508-394-8256 CELL(NIA EMAIL INSPECTIONS EFWINSLOW.COM �..�,_�.__.-. 1 _._.._._.d.......,...�L BUILDING �C:�H.�<R IE�R+iT