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HomeMy WebLinkAboutBLDG-22-000066 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '1�1n-v b CITY YARMOUTH I MA DATE July 06,2021 PERMIT# BLDG 22 000066 Fig-_ vg, JOBSITE ADDRESS 36 CRANBERRY LN OWNER'S NAME LAMBERT KATHLEEN M G OWNER ADDRESS 36 CRANBERRY LN SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—0 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 Iiabilihi 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 NDEMNITY❑ 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 Mark Watson LICENSE# 3842 SIGNATURE MP❑ MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATICN❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MARK D WATSON ADDRESS. 81 CAPTAIN PERRY RD, CITY BREWSTER STATE MA ZIP 026312559 TEL FAX 7 CELL EMAIL piemar83(a,comcast.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No 7/F/Z/ /4 cs 5d THIS APPLICATION SERVES AS THE PERMIT El FEE:$ PERMIT# PLAN REVIEW NOTES ;JL o 6 2021 Q _ It" G M4 1SEIrTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK M141'�s!►r 7 W "` _ 2 L DG ' 2z-000u lo CITY C{ Sv O V MA DATE 7-9 1 PERMIT# ccLLI G o IOBSITE ADDRESS OWNER'S NAME <A h L�VY1 8��T V I 0 DWNER ADDRESS TEL FAX W TPRI O: _J PRINT J OCCUPANCY TYPE COMMERCIAL ElEDUCATIONAL ❑ RESIDENTIAL CLE 11'4 as 4VEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES T FLOORS-4 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 C VT.CIO()f GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN . r POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY OTHER TYPE 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tni n rate to e of o and that all plumbing work and installations performed under the permit issued for this application will be in all P i nt s of Massachusetts State Plumbing Code and � ,Chapter 142 of the General Laws. n PLUMBER-GASFITTER ME 1 v,�ry L\< w Also t LICENSE#3$9 GNAT RE MP❑ MGF JP❑ JGF❑ LPG!❑ CORPORATION 0# PARTNERSHI ❑# LLC❑# COMPANY NAME h M \cS iieg l L Se Qv, ADDRESS 8 ` C A? t Qe\e rry R 1, CITY a 3 STATE NA ZIP 0 2.6 ` TEL L©pit S h b ci 3 7 FAX CELL 77y 2/L 7 q( EMAIL fit e! lc J G 3 l) cowl (act( I`-'� • , nc �� • } # a 7^ Fq... • • •