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Home My WebLink AboutBLDG-22-001685 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �— a CITY YARMOUTH MA DATE September 23,202 PERMIT# BLDG-22-001685 7 JOBSITE ADDRESS 9 CAPT BEARSE RD OWNER'S NAME KUEHN JOSHUA J G OWNER ADDRESS 9 CAPT BEARSE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 1 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 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 Alan Bishop LICENSE# 31513 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ALAN W BISHOP ADDRESS. 23 DANVERS WAY, CITY HYANNIS STATE MA ZIP 026012500 TEL FAX CELL EMAIL alan(a,awbishop.com S310N M3IA321 NVld #111V:13d $:33d ❑ ❑ 1111213d 3H1 SV SAS NOLLV011ddV SIHl oN saA S310N NO1133dSNI IVNU /1NO 3Sfl 210133dSN1210d 3OVd SIN' S310N NO1103dSNI SV9 H9f102f 26-4 • , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _d f---7 ,_ TY Gr r� 01- 11i. ...._ o v r MA DATE ? ) .r y. I PERMIT# ? -1 - ( Car O BSITE ADDRESS ' t ( s. ' -eo. rS' OWNER'S NAME , c -. CC tie V\ ,rN ---1 = .\G :kQ WNER ADDRESS ° t ' f TELH cV -77 41 IFAX J iali TYPE OR.J PKNT _.� CCUPANCY TYPE COMMERCIAL;I EDUCATIONAL J RESIDENTIAL rI �` CL RL� !NE\1v L .= ' : ;,-___JRENOVATION: '.J REPLACEMENT: I PLANS SUBMITTED: YES J NO I a LAPPLIANCO 1I FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 -I'' • . : ., _ -,._1 J . . 1_� ..._____.1 .......__! _—_.__ _____1-___J ____.1 _..__1 _.__J ____.1 1 __.___1 __.___..1 BOOSTER I I —J •� �� _I _I _1 1. I _J CONVERSION BURNER I _ I I' i I -_______I: 1 r _ _ _ J — I ___I 1 COOK STOVE I .1 I _____.1 .1_ I __1 . .. _ __ _____J _______J __ I _I —J DIRECT VENT HEATER • ,' _1 .___._! — 1:_____l, _ __.1 __ . } _ 1 1 1 . 1 �� 1 DRYER 1 ! — - I E I . l :___1 _ 1 . 1 1 _ I I FIREPLACE -- _I . 1 . • 1 1. 1 1 1 l - 1 _._._1 1 i _—__1 ____ ___J FRYOLATOR —__ _! _ _.I I - - -- 1 - i 1 .. _ 1 i I 1 _ 1 , . - 1 _._. 11 _1 _1 0 FURNACE --___-_I 1 z- " 1 _ 1 _ —.' _,_.__,I 1 ___J ___.___.i __..__._.I I I GENERATOR . I i t I a ► 1 i - ! I �: _ GRILLE _. . _ . . _. _ INFRARED HEATER . __1 _1 __—I .. I ; 1 '__._I ---- _,J —J �J ____1 _1 __ 1 LABORATORY COCKS 11 . .�._ —j . _ 1 1 _._...._.1 _ _. 1 __I __ I . 1 1 1 1 MAKEUP AIR UNIT : s ..- - __1 1 ____1 1 s_______ f J I . .J___„...1 ___.._._I ____J._____► 4 OVEN ___r__I _..,..._ ' .__.__! __,,.__..I .____.__; _.._ 1 _____.1 _____J ..____1 _ 1 ____1 ____.1 __..._._....I _......I _...__._..E ,,, POOL HEATER _ i ___I ______J1 ._ 1 Y_..___.._I _-.a 1 ! ._._1 J 1 ROOM /SPACE HEATER _i r 1 ! __.._.'' I . _ I I _ I I 1 ROOF TOP UNIT ._...�...' ... ; __.___.' _I I . I _ _..I `, TEST _._._.__ _.--f , ___.. ! __.; __._.1 _._._ j. ------I -_-.. i .._,._I I UNIT HEATER 1 1 UNVENTED ROOM HEATER . 1 I ! __-___.'' J s _..._._J 1 _ I i ► ..____ .f __ _ i ______,I WATER HEATER ._. -,...::::::1 _ I._...._i _...._.._ _......_..I ( _ .._ _�.. .-I ..._...J _._____1._ .____} _._.. -___J o___...! OTHER ' i `i . i ._____,...._._T: , _.._ _ . - - . ! __ I _....-._... _1 _ _ �___. .1 -.._-_._._ I _ 1 • . I . . i - _ - .. I ��i . I ._ _— - _J ..�._ 1 ____._ __j .. I 1 ..._ _ .. r _.. __ _.. _ . __.�..... __ . , t INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i i NO J I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND I_.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 _-II AGENT .J 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 . • .g ; 7 , 00.. �� f LICENSE# 1 SIGNATURE MP J MGF ^1 JP JGF I LPG! J_ CORPORATION 21# f PARTNERSHIP I# — f LLG #r~ — ~ 1 COMPANY NAME:A .w., 13,,, k_, - Pi.j? ' l'TC7 Li f ADDRESS 3 D- i- 1 CITY (I ,/ q r1 '2, ( J STATE - ZIP Ov1 o j ' `7 7`1 — .5``5 ---- - 1TEL � �� 77 �'f FAX 1 CELL' 'EMAIL' Q/a h G-j► w bI S 4 eft, . ro ,z; 1 f / -- JJC7t - `; _ _ . ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE:$ PERMIT# PLAN REVIEW NOTES •