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HomeMy WebLinkAboutBLDG-22-000853 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 ',i�`1 CITY YARMOUTH MA DATE August 16,2021 PERMIT# BLDG 22-000853 JOBSITE ADDRESS .1i-,,ri<- OWNER'S NAME PAUL MCCARTY G OWNER ADDRESS 33 PHEASANT LANE EAST FALMOUTH MA 02536 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 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 1 FRYOLATOR FURNACE 1 1 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 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 Ronald Nurse LICENSE# 13397 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RONALD W NURSE ADDRESS. 221 COTUIT RD, CITY SANDWICH STATE MA ZIP 025632655 TEL FAX CELL EMAIL ptech88a(�.gmail.com S310N M31/021 NVId #1I01213d $:33d ❑ ❑ ±MW83d 3H1 SV S3A213S NOIlVOIIddV SIHJ oN saA S310N NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 210d 30Vd SIH1 S310N NO1103dSNI SVO HOl021 __ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t'= CITY: cm--v- '0c`"01 MA. DATE: ^ 13 •1 ) PERMIT# 'LZ -`LC JOBSITE ADDRESS: 1 .S . ` Iv-NI'e- S C'04. OWNER'S NAME: Me ear`t,\� GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO Cl APPLIANCEST 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 I _ FRYOLATOR FURNACE , GENERATOR GRILLE _ V} INFRARED HEATER w LABORATORY COCK MAKEUP AIR UNIT _ OVEN � C E 4 V E POOL HEATER __.�.. ROOM/SPACE HEATER • 1--- _ .I ROOF TOP UNIT A I :j 2021 TEST >, UNIT HEATER i.ki UN VENTED ROOM HEATER BUILD NC; utr UIN FFRrIVT " WATER HEATER ( ®v -------- --i — I 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY Q 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 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 P ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. f/ - 1 PLUMBER/GASFITTER NAME: V(-�L LICENSE# i (� —� SIGNATURE) COMPANY NAME: \0 his-\c2,,:iry T 1n,-zioj ADDRESS: Q, . e.C.7"-''''k'Staol l CITY: S c .l kv\ek L : c•I.-. STATE: 1,L-►'i ZIP: [��SL 4, FAX: cJ TEL: CELL: r1Po i1c69 ENTAIL: �C L 6,A„� ' r u G;` MASTER El JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP 0# LLC❑# c ryiniL ADDQe-Ss : C_J ( 41--- SG/Z 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