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Home My WebLink AboutBLDG-23-001632 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'wl- CITY YARMOUTH MA DATE (September 27,2021 PERMIT# BLDG-23-001632 JOBSITE ADDRESS 9 MILLARD RD OWNERS NAME MORRISON PAULINE R TR G OWNER ADDRESS PAULINE R MORRISON REALTY TRUS 25 PINE ST WATERTOWN MA 02472 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:disconnect gas meter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO 0 IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 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 Robert Brodie LICENSE# 30565 SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME: ROBERT D BRODIE ADDRESS. 184 VILLAGE LN, CITY WELLFLEET STATE MA ZIP 026678119 TEL FAX CELL EMAIL northcoaslphWprotonmail.com • S31ON M9IA32:1 NYld #±IINb3d $ :33d ❑ ❑ iJI JH3d 3H1 SV SIV213S N011V3 lddy SIHl oN saA S31ON NO1133dSNI 1VNId AlNO 3Sl 2i01c3dSNI dOd 90Vd SIHI S310N NO11O3dSNI St/J HJflO21 .. f 3 . > TO s� @ �USETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -...CITY �,�py�1��i"//'r MA DATE �� ^� PERMIT# 2-3-2-3— Ha Z ' T-) SEF , � �� /a r II DD?ESS l( OWNER'S NAME i of N(I.;OWNER l4DDRESS _ c � TEL FAX T�Pt-flirt" OCCUPANCY TYPE COMMERCIAL TCOMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAJ CLEARLY NEW:El RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED:\ „UBMITTED: YES❑ NO❑ APPLIANCES-- FLOORS-4 BENT 1 2 3 4 5 6 BOILER 8 9 10 11 12 13 1 BOOSTER �_ CONVERSION BURNER ----- COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE -- FP,YCiLATOR ---, 1 �___`_ FURNACE GENERATOR GRILLE _-- r-- INFRARED HEATER LABORATORY COCKS - _______1MAKEUP AIR UNIT _ —_i OVEN 1 POOL HEATER i ROOM!SPACE HEATER --- ROOF TOP UNIT , TEST _ UNIT HEATER . • _....... - - - --- UNVENTED ROOM HEATER • WATER HEATER 1 f�i HER __ I /g t ‘7_ - — INSURANCE COVERAGE I have a current liaf,ili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YErk NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW / LIABILITY INSURANCE POLIC' ] 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 ❑ SI NATURE OF OWNER OR AGENT ',I-• 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 4!`-- 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 l Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFIT TER NAME jh 30 �LICENSE# J IGNATURE,j) MP ❑ MGF❑ JFK JGF ❑ LPG' ❑ CORPORATION ❑ii PARTNER. HIP❑# LLC ❑# COMPANY NAME_ < /� ADDRESS sr) • 6� < 7 y CITY STATE ,l ( - ZIP (.9'.2,,b I TEL FAX CEL rz 29 EMAIL OUGII GAS II*ISPE�=TION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT ft • PLAN REVIEW NOTES • •