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Home My WebLink AboutBLDG-23-002561 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 08,202;PERMIT# BLDG-23-002561 JOBSITE ADDRESS 4 PUMP HOUSE LN OWNER'S NAME CONNORS CHARLES V G OWNER ADDRESS CONNORS PAULA M 4 PUMP HOUSE LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 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 0 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 'Andrew Leighton LICENSE# 16130 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME. 'ANDREW R LEIGHTON ADDRESS. 120 Brewster Rd, CITY IW Yarmouth I STATE MA ZIP 026735706 TEL ' FAX CELL' I EMAIL Ihalloilcompanv@omail.com J R 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 '== - P ( 61 , ,•--------- r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING i,�-_; WORK s Swims T. ui ; CITY _ I • MS? s> MA DATE �a 3ta o� PERMIT # JOBSITE ADDRESS �-- 0 OWNER'S NAME cul e_J� , G OWNER ADDRESS =_.‘"________ .r "� -- � � ' �.__.-_.A TYPE OR - _,�_. . T -� � - ��I �F Y��...�.=.a�:.-.;�....�-�.t PRINT OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL D RESIDENTIAL '•-""----- CLEARLY NEW: _ ENOVATION: Li REPLACEMENT: L PLANS SUBMITTED: YES U NO I APPLIANCES -1 FLOORS-► BSM 1 . 2 3 4 : 5 6 7 8 9 10 11 12 13 14 -: BOILER . _ 'LM � E M IIIIMI._;.- -- BOOSTERAKIMORMINIIIIIIPMMIIIIIMIIIRMIT CONVERSION BURNER _ -.____. COOK STOVE � � ��- �- I DIRECT VENT HEATER I DRYER _ r_i. � M� . ( FIREPLACE - • �r--- � � { ._ _ FRYOLATOR --' �-,'�_-._._�,r-_.. -==�=-�,t��=:-- �_ _�_ -�:_:-.� _.��:--._. __;-.f __t=��:�_I - - r = - ''-�_ �� FURNACE ;-- - ii'-_ i __ _ --� - _ _ I._ _ -,-11 - I i. _____I FURNACEFURNACE - ��1 T` - -I--, - ; ( r--- _- - MI(-- -lit - _1 GENERATMMIIIIIIIMIMMitMIMENITI GRILLE HEATER M ' � # - - . i -�_... _ �:ft INFRARED MilliM LABORATORY COCKS - - ' — MMI -'f =- i .: _.. MAKEUP AIR UNIT r OVEN - r= t POOL HEATER -- `�_ __ --';,__.__ �� II }._ ROOM/ SPACE HEATER ' Amurimmilommimmaginsimer ._t, ROOF TOP UNIT MIs_�. . . , i (-`_� TEST �F TEST T HEATER — : � �� IM Wifir L__ - ` UNVEIVTED ROOM HEATER _.-_: �_ i - ' L .____ L_ -.�_.. ' WATER HEATER c _ �� '� • `_. __ ' i OTHER _ _ _ MM. � ;i>r._ Jr-—� _._._.. _. _ __ _ . _ ,. _.,__ ,_ _ Awmmuitmmwoutiemmtw_. ,m-inirwrim ,. ._ immmvuslimintomm"manimmlimais iMMIMM.M INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES i. giro I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY U BOND 71 OWNER'S INSURANCE WAIVER: I am aware that ttie 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 fl AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicati are iru and curs to the est of my knowledge and that all plumbing work and installations performed under the permit Issued for this application w1li e in com Banc with Pertin . t provisionof t Massachusetts State Plumbing Cade and Chapter 142 of the General Laws. P the - 'PLUMBER-GASFITTER NAME •/? ( � C.-z- 7-y' LICENSE # .1 SIGNATURE MP Itiiii MGF LI JP 0 JGF J LPG! L. I CORPORATION ,': # ;_ PARTNERSHIP ri# LLC r- COMPANY NAME:_ f�_ X.0 ADDRESS , ` .�.w '- ,� j CITY .5h _ - s = STATE j ALI ZIP Lc3 b , C TEL 1 - 3 3-$ i _„,...„j FAX E- 0_, CELLI �.� . _ . _-- jErvIAILA,o/r-1_ � .- �,yrU- r G--; z-'/37 � ' f