HomeMy WebLinkAboutBLDG-22-002825 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
ILCITY YARMOUTH MA DATE November 16,202' PERMIT# BLDG-22-002825
JOBSITE ADDRESS 33 CREST CIR OWNER'S NAME David Palmer
G OWNER ADDRESS TEL
TYPE OR OCCJPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 111
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 ,
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR 1
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
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 CHECK NG 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 o'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 Seneral Laws.
PLUMBER-GASFITTER NAME LESTER WADE LICENSE# 4569 SIGNATURE
MP❑ MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,
CITY COTUIT STATE MA ZIP 026352702 TEL
FAX 7 CELL EMAIL
S310N M31/02i NVId
#1I012j3d $ 333
❑ 111A1H3d 1E11 SV S3A213S NOIJVOIlddV SIH1
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S310N NO1103dSNI 1VNH AINO 3Sf1 210103dSNI NOd 30Vd SIHI S310N NOLLO3dSNI SVO HOfOa
fiAASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM FITTING
filE ii, GAS WORK
.r ; y CITY I kic.r' tA.CUl•k MA DAZE 1 -1122_ 2�' Z C�
s � r - - ! PERMIT
JOBSITE ADDRESS L3 3 C(..t-,.4- 6: r . DWYER'S NAME v+' ci Pa.( ry -f`
`� ::i OWNER ADDRESS Sta... cLbo J e., TEL -1ss1-3.5LI.- 5 7e)) C FAX
TYPE OR .
•
x'I �..t, OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL f i RESIDENTIAL
NEW: RENOVATION: i,J REPLACEMENT' Fl PLANS SUBMITTED: YES ❑ NO
APPLIANCES 1 F `
LOOPS 1 SSf,,l l 1 1 2 3 4 E 5 6 1 1 8 1- 9 10 11 r 12 i 13 i 14
BOOSTER i•-11-`_`i--!! -- -I II ==y----- ;-- it f st.�'� r 4 +
CONVERSION �__-- - s--- II t - ;_ _—F1----i----i-- -
..._{ • I
BURNER (— s �" :i .(l i -
COOK STOVE li — - 5---- , .
DIRECT VENT HEATER n-. ~i? — '� .._... -_1 `7�- -•i :1=—
DRYERI ...,....... _ :- t- - L sL
L g
if--I
FIREPLACE t i;- ; --II - - — --- == -- _s.._. '�. �.a S
GENERATORFURNACE I '1.
,-.__.__,_.✓; , ._ ..�'. --•.1;-._. .._ �� __...��.....__,_ ._. .�._ ...._ .r��_. •�-� _�..�_-r �-.-�-_-'��NN .� .:.f.,
E it 11 — hf- t - .�' --_+t i' f
GRILLE IL__I z' ���'- �- _ 1 __ ...�.1 ..�_ 1
INFRARED HEATER 1-11--11
Al ` ,:t_ I 41—li_--7—T!_,__.,_ } -----j,1LABORATORY COCKS FIT..
-- ,�—If li ._. ----i 1 . - n _ :4-,_.._..�
r ti __� tt 1 �� it i _ "_ -. r-. ' , . 1 _�.....:j
MAKEUP AIR UNIT _ �' �`� � 1
OVEN I . 1 ► .1`i'� a �i ''1 f i ......�+ _�_ _
POOL HEATER If -._:._ " - .n-=-�-- = -4 =�r. =w: = - _:.._. t=__.__ -___- -
ROOM / SPACE HEATER """�.-`- '}I 1 - -.. I t li 1f��' 'I t
ROOF TOP UNIT jI J •1 __ li. 1 .------I II -----;f--f =_ _ _
I TEST I _-_�, ___�r.,.. _.._. � ..:_�._. ..1,.___. ,,1�_.,__1___,�1
ii
il
UNIT HEATER , I {f- r'11t� _; 1i--- a
_. ..i.r.i..`.iM•.++_..d*a 'i..ta/.�o►,j u4-a.1.w.• ..y._+...MMw.�.A+-_ •
.^:nG.v........+Yli►aAC/.'.r?.w..�•�._•�w •1.J16Cf.R.
UNVENTED ROOM HEATER C--� `fit- ;' '' I� � t ( 't - �"
WATER HEATER g t i, a , - - --,: - 7
- .r It_ INSURANCE
-r,.e.li. .._A_'- _• �J.r.L-..... II_.. ._ t ..'.1 .ice• _ ,]4�..a�._: _f• .. '��.. -' 4
COVERAGE ,
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. -142 YES 1.
10 , 1
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BQ;; BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY II I BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 oi the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK!ONE ONLY: OWNER L. AGENT C
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 ins,aliatiors performed under the permit issued for this application will be in co,. pliance frith all Pe :'nen► provision of the
Massachusetts State Plumbing Code and Chapter •142 of the General Laws , J
PLUMBER-GASFITTER NAME I Le5, r- (Ai a._et e. i LICENSE # 145ty r1 SIGNATURE
MP iviGF [l JP El JGF 0 LPG! CORPORATION E# PARTNERSHIP F14 LLC
COMPANY NAME:IC p Led .,,,e_p f,ut.e,a- pirkkOPRESS Q3 &c,wvldc el-, �'..41-
CITY Nia.51.ti lag STATE ! ZIP Oat; LJ 1 i T EL [ 50. --trr7 . 13-7
FAX f 10ELL! E) _ Z1 JEi!AIL Irk `ti
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