HomeMy WebLinkAboutBLDG-22-003548 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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1f CITY YARMOUTH MA DATE December 27,2021 PERMIT# BLDG 22-003548
—
JOBSITE ADDRESS 67 CRANBERRY LN OWNER'S NAME Thomas Myers
G OWNER ADDRESS TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ID
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 i
,
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 CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 LESTER WADE LICENSE# 4569 SIGNATURE
MP 0 MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME: 'LESTER J WADE I ADDRESS. 22 CAPTAIN ISIAHS RD,
CITY ICOTUIT I STATE MA ZIP 1026352702 I TEL I
FAX I I CELL I I EMAIL I I
S310N M3IA3H NVId
#11WLl3d $:33d
❑ ❑ 111,023d 3HI SV S$AHSS NOI1VOIlddV SIHl
ON SO)
S3LON NO1103dSNI 1VNId AlNO 3Sfl N0153dSNI NOd 30Vd SIH1 ShON NO1103dSNI SVD HOf10N
W ASSI'ICHUSE i TS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
c y7.F' CITY ► l e cv�. 0 J MA DATE f ').- ; I PERMIT 4-
JOBSi T E ADDRESS `v' 7 6r aL-vt h C_rlr-t� L t'i . DW! ER'S NAiviE 1 C�"i, 4- K1� ,' E .`ti i CIA -r t -(3
^a 1
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OWNER ADDRESS S . L- cL !l to o TEL r , FAX
s i' '" OR OCCL,PANCY TYPE COMMERCIAL n EDUCATIONAL El RESiDENTIAL
`'z.,"`0'�Y NEW: ZI RENOVATION: D REPLACEMENT' [i PLANS SUBMITTED: YES D NO
APPLIANCES Z FLOORS J BSM ( i i 2 3 ,I 5 1 6 1 7 1 8 1 9 J 10 1 11 1 12 13 14
BOILER ,..=----fl __.�J•___.._{;_ ✓�� _, �E li.--__.j•_._- ,l ... .__.K.
CONVERSION BUPNEz if, -- I -- „ .�__ ,1 --{ - � ----1_ ii i __ 1�_ �_.`._1(:�.,lr
COOK STOVE 4 1. ` il 4t _ji ' I, i'• i'_ _ _ii `_ ._1
DIRECT VENT HEATEI? II __ r�r--4 I - 1—_1 -� ?; i��` _� i_ _�- 1�'
FIREPLACE ,__ } '`� _ `' - }r �il �_l --� `i -. _. '
FRYOLATOR l II 'Ii - � i.� _ a 1 ';
FURNACE II_ 11. _ ; -- — _ i . _ r I( J+ I_. �� - ( - �{GENERATOR Ii ✓ f 1' J(_ .' , i, �.'I _ , :?..._..__ ...�..y +l _ . �I C
GRILLE �(�—`ice__ ,a � �I ui(_ r_ :n
INFRARED HEATER -'it i `' , �! —„ r
LABORATORY COCKSF ,.;—: _ r--- _-----�. ------!---, t: - . .i t
MAKEUP AIR UNIT iFTlii II----_^ ' ;� - il�il , :; _�;� 7� _
OVEN I�«�--- ` - 'i - i _.,I�^L�`. 1 _ _i; ;f' -''j ( -!
POOL HEATER 1E _ Jr- 1; _1 ._... .1� iJ ti -11 .L - i . 11 .- t
ROOM / SPACE HEATER I II -,r= ,I - �i _ --��11 ��' .. _ i '( i
ROOF TOP UNIT �, -,r-- i�--- a, i:__ _ , �, ;
II .1._ �I �_ is 1 L � `� _._.J' � 1� l__ _. -_ z,:R. L._—
I TEST iI ::-^"�i s ,� ;i "ti _ii- , ._ �� l -
UNIT HEATER i �;� _-_.�~-- =► __ '� :;_ y�_ �i—l : ,:.��..�!..s :.n. ....- :r ,.�... -y
UI�IVEr�T ED ROOM HEATER I � _`��� �` )) ff `1 `_� " `�
WATER HEATER r ;I I i rI l 11 _it. y_ �, I� — i -
OTHER fir-` _ :: _ __- .-- 1,. t, - �Lr
l_.� ._.� _..--_--_ __ _ {I- II_ :+ _ _ t _ ,iI F _ al _.__.._+:. .;11•_,
1.
i L L. _. •+ .. _-.. if • .. .1_. ir !- �,
�IiNNSURANCE COVERAGE
I have a current liabi,it\' insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i'10 H
i iF YOU CHECKED YES, PLEASE li'4DICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BD;; BELOW
I_IABILITY INSURANCE POLICY ✓� OTHER TYPE INDEitiIMIT'1' I(( BOND '
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coveracie required by Chapter 142 of. the
MMiassachusetts General Laws, and that my signature un this permit application waives this requirement.
CHECK ONE ONLY: OWNER 7 AGEN ► I
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or enierad 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 win be in co plianre Ath all Pe :•nent provision of the
Massachusetts State Plumbing Code and Chapter '142 or the General Laws 0, p, �Vae,_---
PI UMBER-GASFITTER NAME ! Lt c4cr Vitt cic• I LICENSE Y11+5(061 SIGNATURE
MP MGF vI# JP 1 I JGF L.j LPGI l 1 CORPORATION 04
j PARTNERSHIP I�rI LLC Cam.
COMPANY NA'lE: ; ,pe, C,%ici ,, ` zt le,Ag.Lefi+ p ,fpP ,ESS l :23 gc,„t cee (ti, Q -
I STATE ! M, ] ZIP ,O t; 1 TEL 1 50 S -cf 71-• S- ' S-
CITY � [L��.2 SLR fa� � --- "
F',.:,< i 1 CELLI 4) -. .`z' ' jEMAlL t '4 b Cf'. c..L i ( Gi e-,,,-,,,F o'-e.-+c i-.; . C.4'• in