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HomeMy WebLinkAboutBLDG-22-003811 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11 tliV., CITY YARMOUTH MA DATE January 07,2022 PERMIT# BLDG-22-003811 JOBSITE ADDRESS 51 CURVE HILL RD OWNER'S NAME Manuel Atienza G OWNER ADDRESS 51 CURVE HILL RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 DRYER _ FIREPLACE 1 FRYOLATOR FURNACE GENERATOR ,...,,,_„------ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 1 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 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 E MGF ❑ JP❑ JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa[7a coastalphc.com S3ION M31A3b NVld #111NHAd $ 33d El El 1IV 2d 3H1 SV S3AH3S NOI1HOIlddd SIHl oN saA S310N NOI103dSNI 1VNId AlNO 3Sfl O103dSNI 2JOd 39Vd SIHl S310N N01103dSNI SVO H9flO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . avoim, -Mt;k=, CITY South Yarmouth MA DATE 01/04/2022 PERMIT# 'T-Z" 3'bt( JOBSITE ADDRESS L51 Curve Hill Road i OWNER'S NAME ; Manuel and Jean Atienza GOWNER ADDRESS I same TEL .FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Lei RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:. REPLACEMENT: PLANS SUBMITTED: YES 1 NOD APPLIANCES 7 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER • - r— BOOSTER I �r CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 1 POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 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 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 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /J/ �2B' G�/.lg PLUMBER GASFITTER NAME Troy Gilbert LICENSE# 13573 /j GNATURE MP MGF JP JGF LPG' CORPORATION # PARTNERSHIP; _ # LLC # 4350 COMPANY NAME: Coastal Mechanical ADDRESS 21 L Fruean Ave • CITY South Yarmouth STATE MA j ZIP 02664 ,TEL i 508-737-8747 FAX CELL 508-850-6955 EMAIL lisa@coastalphc.com