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HomeMy WebLinkAboutBLDG-21-002460 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK sit CITY [YARMOUTH MA DATE November 03,202( PERMIT# BLDG-21-002460 JOBSITE.ADDRESS 21 RIDGEWOOD DR OWNER'S NAME PATRICIA KELLY G OWNER ADDRESS 21 RIDGEWOOD DR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 © 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. Jai (:).o , � 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 Timothy Mcelroy LICENSE# 15993 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: TIIv1OTHY M MCELROY ADDRESS. 70 Cranberry Highway, CITY Sagamore STATE MA ZIP 02561 TEL FAX ]CELL EMAIL tim(a1capecodmasterplumbers.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 l�P G —Tsi O/Y FEE:$ PERMIT# !t/S72d oU. "4 PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT' TO PERFORM GAS FITTING ►r_;v,�, WORK @jti CITY jj , �, I' t t .Cz.�rvt. 1/`.� MA DATE[ ; PERMIT # X/ .�/ e �� JOBSITE ADDRESS i t 0 da.,_t, �JOWNER'S NAME jijf....e.iik - OWNER ADDRESS t 0 TYPER fi. . ..._ f TES 2: $ FAX . U OCCUPANCY TYPE COMMERCIAL.1 ! EDUCATIONAL RESIDENTIAL PRINT CLEARL.b' NEW:1 ..- RENOVATION:LI REPLACEMENT:A\i PLANS SUBMITTED: YES' ; NO APPLIANCES Z FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 BOILER M _ _ . _ - -- # _ ,- -- . . -. BOOSTER ._. 4 AP CONVERSION BURNER31111111 ...... . :_ . tit,. .• :� COOK STOVE t - - -. �. psi . DIRECT VENT HEATER DRYER _ -- �. � FIREPLACE I .. . ' . r t ,-2- 4 t _, - /l -A _ ;- 'x -' FRYOLATOR --, —. _ ,. - _ - - _ . -,,, .. FURNACE - .,. � _ -� � ., -- . -� _ �` .. .� t • - - r ,. f_ _ GENERATOR 4 - : 4 . 4-1 f: : • . _ _ . GRILLE - - w � � INFRARED HEATER �, t LABORATORY COCKS ?t i --Mit ' - :r MAKEUP AIR UNIT rt - OVEN . ' POOL HEATER = 4: : , r• y� ROOM / SPACE HEATER , ' -,- ._ _ - ROOF TOP UNIT :•; --- - R - -s s�= a * . ... - m TEST :" . 4 v . - :s z�. A24 aE I. -yam,,,�,�.�,, � , ��c- �r-+ 1<fix ••a.4.. : — x 4 a ' !..J¢- ._� C R4..� -.43.4—;<a7 -•< #. a a..4.34iG.,..., _ - 4 UNIT HEATER _ 1 �_ UNVEIdTED ROOM HEATER ttizt ..--iib;- : '• i - - -{ ' s -, - . WATER HEATER F OTHER L `__ _- - • ---ilab t �- � 3 r.,. f � f a +ti�ri�c`A-� i i 1 t ITT _ - r B- INSURANCE COVERAGE I have a current liability insurance policy or its substantialequivalent which meets the requirements eq of MGL. Ch. 142 YES ill NO j 7 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ( OTHER TYPE INDEMNITY [ i BOND 1 1 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 ! I 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 PertinnnLp ision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. PLUMBER-GASFITI ER NAME L•� i LICENSE #!! .. �cG4 SI L . .�y_ l AT MP R MGF i 1 JP j JGF I j LPGI E 1 CORPORATION PiL 1 PARTNERSHIP 1 #j ! COMPANY NAME - L..` -- <)-- Ul ci \L,�a d- ig„?1Lt.Yy t, t. 1-ADDRESS TO cJ - .�c k CITY a_ � _ . mr,,,, 2, J STATE IN1,A J ZIP - G`off u .l }TEL FAXI CELLjEMLjTh ._�_ _ti.�._ j ---„se _ . ...1 . . .� ,, am . CA-lie-CC-0 1 -L&g g 1.1-&.. /; , 1 , M `