Loading...
HomeMy WebLinkAboutBLDG-21-001477 I. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - 1 - CITY [RMOUTH MA DATE September 22,202 PERMIT# BLDG 21-001477 JOBSITE ADDRESS 49 PAYSON PATH I OWNER'S NAME HADFIELD STACY A G OWNER ADDRESS 49 PAYSON PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 FRYOLATOR FURNACE 1 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 s. 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 requ rement. SIGNATURE OF OWNER OR AGENT a 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 fcr 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 Edward Warchal LICENSE# 16429 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [EDWARD W WARCHAL ADDRESS. 61 JUDSON RD, CITY WEYMOUTH STATE MA ZIP 021881414 TEL FAX 1 CELL EMAIL r� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NbTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ., vviY77 CITY: \�GrfiiQa'''l MA DATE J/6 - a0 PERMIT# JOBSITE ADDRESS:c?? /1. so/l1� OWNER'S NAME: .&ibfYc G OWNER ADDRESS: TEL: &(,)- y /73( FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALW PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0' PLANS SUBMITTED: YES❑ NO 0 APPLIANCES3. FLOOR-, Bsmt 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 FRY MAIM r " FURNACE GENERATOR GRILLE INFRARED HEATER IQ} LABORATORY COCK MAKEUP AIR UNIT' 1 OVEN POOL HEATER ROOM 1 SPACE HEATER - "� iERNfott 1 ROOF TOP UNIT Z TEST UNIT HEATER ti V UNVENTEc ROOM HEATER WATER HEATER INSURANCE COVERAGE h / I have a currentjpility insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 VESA NO ❑ If you have checked Da,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0( 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 El AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this applcatlon are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit Issued for this appilcatton In ance all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1421 the General Laws. � PLUMBER/GASFITTER NAME: /�h..4/ Ali/P/�,7 LICENSE# �d Yo?? SIGNATURE COMPANY NAME: r/& Putt. IJii / ADDRESS: ./ Ju� CITY: O U\Lk U STATE: AIL ZIP: 146 FAX: TEL t7 ` 717- 71 f' CELL EMAIL. /'-/Ey CS J lv �f �� . CC-Y`1- MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑ E h?/f/<'. 09,0•Z,e-SS MOW,OM 3 MO talAd A39 0T TIMIqF 4 A sic;4OTrA 01.I0 aA St70-4 5111 ttTSEUH 1 _ '.- CCY1' -is-a 9 •?�:a :\ • :3Tao... Alll.__._.____- v < frno 1.,1i , _.._ ^t 'r"".„3 eg. ,1-"IrY c, a,,,,w?„ t3K10 .1_.. 7. yam'; -.L3 11•311(1101. r _g 1- _:e631:1s7t7AfiViSt7 0 )4.10E145a1E39 ❑JAMOITAAUC33 01v:;Y3MMOO 39YT YbtIA9U030 il0 9p5r3 0 GIN 0 ray:tf rmose 9AJ9 ?v'.T'-'V:'3:A W3? ❑:11OtTAVOM3A Offl Yt YJNAara •t I I1 ' 0 . a T L 8 _j.. _'_ n r 1mei i. f - a �/4 1- �1 _- Y.44. '' -4- / _ 4- - r -,4---4. —L----.1- } {-- V - J _ •_11 - ` y 1 r-- 1 __, . I._-�__ y�(;4— i 1 4 -+' __�_.-.._.1 {'' 0 Olt pk8l1' SOtJ$3.J061leUt ri:v*1p ill7N.A.-1-14-Nt..:,,..41191612+OzdtathR. t:,!lager4estIZ A, fhstrroiAIM1 woied sod etenga1gqs orb Qtdttoork Otmintivo3 to eq1(;it nIeothal eesetq Arbitub.Yett UOG■ ❑woe 0 YTIIIM3ON134YTA3100 It YaLgYi 3341Aquees YTIJMi.I eAblIR ttpllslst - -,.. :. - t�l�-'I' wigs li=sesf>:;:.-T-I! .?**VOL.i'� . 1. 24Mi.A2..1. I Thee Siffiett M0 otyll istlIKfMr tbnssuitso sslggsddt (bsshea)be +dusNttdInotlsanaiiSntetll<tlbfittktkidnei,V6s0 • 11 IIIR it el-live Io1iO*III ttbetaiHkmoQeA1 tau 0snnolaaq pnaildsfai tins tow gnidtsfq#ebryWsepis et ad Iswia0 e:4'9c IP',PlcIter2 yla 0)0 rkIrsul904aNeeurbeeieMarlomlehaq uTA►gIa i_ !`_ ? : 3S:CA_. =.1:._.' ._„. ;k . 'l. .y l-1p� ;3t�iM41�ig1Aau100 J(A3 r, a} :`AI _,.ATE __�. _,"'1'' N\K• -1_:Yin .t❑3.0 4 C i'+z�avi •i a❑140r,SAO OO 0 JjAT2l4!gJ CI vv [MAY3I49JOt 'gTreaM tz sSrCS J� a 4