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Home My WebLink AboutBLDG-22-003418 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �" M CITY YARMOUTH __ j MA DATE December 15,202'PERMIT# BLDG-22-003418 e JOBSITE ADDRESS 169 CRANBERRY LN OWNER'S NAME BERGSTROM IRENE M G OWNER ADDRESS C/O HARNEY DONNA 104 POND ST SOUTH YARMOUTH MA 02664 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 _ _ FRYOLATOR - _ FURNACE GENERATOR 1 _ _ GRILLE _ _ INFRARED HEATER LABORATORY COCKS . MAKEUP AIR UNIT - OVEN _ POOL HEATER 'ROOM I 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El 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 LESTER WADE LICENSE# 4569 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD. CITY COTUIT STATE MA ZIP 026352702 TEL FAX CELL EMAIL S310N M31A3271 NVld #±ILN J d $ : 33 ❑ 0 1I JJd 31-11 SV S3ALOS NOLLVDIlddd SIHl ON SeA S310N NOI103dSNI 1VNId JCINO 3sn 10103dSNI 21Od 30dd SIHl S310N NOI103dSNI SVD HJl0H �� MASSA'ACHUSE TTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -- r, ' CITY I y at MO MA DATE RtLitt I PERMIT # Z -3y i Y `ryti- JOBSITE ADDRESS [T11Iq um Erni LN •. OWI ER'S NAME Mitt \&U tX ,,..„, ': :; OWNER ADDRESS 1 Stc.. cLAOoNI TEL 17zi • ai a ' atirlai-Ay PRINT�" OROCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL r i RESIDENTIAL • CLEARLY • NEW:E RENOVATION: I REPLACEiv1ENT• PLANS SUBMITTED: YES 0 NO 1 APPLIANCES 1 FLOORS-. 9SM L i i 2 3 - 4 I 5 1_ 6 1 7 8 I 9 -I 10 11 1 12 13 14 BOILER "----if, _i, rw. _ �. BOOS i R __ '( � F— — '' ;� —_ y__^ y ti _�_., Sr----;I ;i L ,, CONVERSION BURNER - ;1--- I- 5� - _ --•.i; �-- -ii- y�_ .�. _ •___ I„ �� • COOK STOVE ;I —��_ _ .� _ }_ I_ __i ._II_ _ _ .._._ _ �.�..._: DIRECT VENT HEATER �i� __i--r�� i_ _ '. ._ - 1i-rWt; �7 j-1 ....•.1� _ __ ._.e'S.•w_j..s� ter..at DRYER 1 'I !� l - -�- -� '�! 11 .r:• Avg FIREPLACE `' ___-- .,11 j _- •r -_. __•_-_.' j :' - �_-.-_-,_� _ —r „: _. �.' -f�-u�' ---^}� ='t� _-.__ r ___ tin '_ FRYOLATOR • II~ Y - `�-- "Ir I `_.� ., _ - -, _�.t' FURNACE 1 . .I_ -,11 _ :- i „---- ----1F --i�r :�i_._.��- _ ! _ ' _ . .- R GENERATOR ...____:.....:,..-_-_,........1:of I i _ . }. _.-.II _. . ..�_ __Al.;__ '1 ._ i GRILLE ;(i!'�� _ ;��;, i�- xl ;-� r -...-s'. w �3 n_ INFRARED HEATER Ir--(_!;E `i , �'l —?�1 � !_ �_ I LABORATORY COCKS r�; 1�_" i '1--- y�� —` I' �.._ :1 ''` __ I a - - - .- MAKEUP AIR UNIT 11 i i-`-`ir-ili..- -1 �E 1. 1I1.-'i` -- r_.3 _ . OVEN jl��(~.�i � 17--.- .._-_ I__ __...4.[.....i.............„...,„.......,___:.....4..! i- �.-, ` ._..... . . . POOL HEATER II ii I ,�. '� r :1i _.___. . .I .. ' P,OOlv1 t SPACE HEATER I 'il it. II_� • Y ;ri. .1 a ��'^ 'i 1 ROOF TOP UNIT I jI, ._. II . I ---1 _ ----11 _._.in L .._i ___,_.1__ ii__._.. 1_ _____11----7 _ 11 ----(j ._ r 1 I :: `.1 + i TEST 4._ s..- ,._..�.......4....:��.._..�.._:� .._� �.....__; ,- �..._. .:�.....,.. I. UNIT HEATER S ...%�. - 1 '- - —_E—'l--L I.. _ y J ,'_—' - UhlVENTED ROOM HEATER ; `� 'I� �! �I + WATER EP, HEATER „ Y� i •l t' _ 1 .__ _._.__ �� r• i OTHER IF-7 -`]. ._ ..: .....:.....:'L.._,...._.! ,L_.___.--- . ...__-._... ' _ .I 'i_ i !• - - , 11 .J1 ,, .1 y_IL -' -•'' Tli 1 � -c.`�_ ! -ii_ _. _r_ _.,_ '„ .._. _. —L i ' .-.�. • -- _�..L-Ir__ i% -- . _..i ._L... ...•.._i' r.-J am..:_.�:.., _-.-- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 110 7 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ✓ OTHER TYPE INDEMNITY El BONI) - OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverace required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER I AGENT El 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 co plian:e with all Pe :'nent provision of the Massachusetts State Plumbing Code and Chapter 1.42 of the General Laws 9 e t� (Jewe' PLUMBER-GASFITTER NAME 1 Le5 r_ 100eie{e- i LICENSE #1 450Ci SIGNATURE MP n MGF (-- " JP E.j JGF LPG![Li CORPORATION 0#I I PARTNERSHIP DM I Lc j F COMPANY NAME:Cap Lt"4 14- ,u, ,„lite,+ Firkkop'RESS I 33 gcs,,x(c i-v P..41- _. CITY I1,4Q S&L pe. C.,. STATE ! /IAA IzIPE oaG &( 1 I EL 150 -kf7? S" 'S"7 , - 1 FAX 1 10ELL - 5V-' EMAIL t'Y 4 b L. C.C, t' p 1 e..i l,N-M . 4-4 , tom', tA\ &SS"