Loading...
HomeMy WebLinkAboutBLDG-22-004260 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r1y CITY YARMOUTH 1 MA DATE January 31,2022 PERMIT# BLDG-22-004260 JOBSITE ADDRESS 43 COVE RD OWNER'S NAME Cove Island Ventures Ilc G OWNER ADDRESS J TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ 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 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 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 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave. CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisataacoastalphc.com S31ON M3IA32:1 NVld # $:33d ❑ ❑ 11INb3d 3H1 SV S3A2i3S N011v011ddb SIHl oN sa1 SRION NOI103dSNI 1VNId KINO 3Sfl 2i0103dSNI 2lOd 30Vd SIH1 S310N NO1103dSNI SVO HOflO I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " i;i= ' CITY: Yarmouth MA. DATE 1/27/2022 PERMIT# z' ' LI 7-6O JOBSITE ADDRESS:43 Cove Road West Yarmouth 020730WNER'S NAME: COVE ISLAND VENTURES LLC GOWNERADDRESS:305 UNION S Franklin, MA 02038 TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[2 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:2 PLANS SUBMITTED: YES❑ NO❑ APPLIANCES1 FLOOR-. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER V BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER _ FIREPLACE FRYOLATOR - FURNACE GENERATOR GRILLE VI INFRARED HEATER W LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER �) ROOF TOP UNIT fi TEST UNIT HEATER t UNVENTED ROOM HEATER WATER HEATER 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 2 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 /96>E44L CHECK ONE ONLY: OWNER AGENT ❑ SIGNATURE 0 WNER OR AGENT 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. /2,4 eA PLUMBERIGASFITTER NAME: Troy Gilbert LICENSE# 13573 ( �GNATURE COMPANY NAME: Coastal Mechanical ADDRESS: 21 L Fruean Way CITY: Yarmouth STATE: MA ZIP: 02664 FAX: TEL: 508-737-8747 CELL: EMAIL: Katherine@Coastalphc.com MASTER[J JOURNEYMAN 0 LP INSTALLER❑ CORPORATION[#4350 PARTNERSHIP❑# LLC❑# E - igiakeze ss . � - _ ' ��� ' � . ` - ' N � N _ � -__ _ _ _-_-_ _-- '__-__' - __-_' - _- _ -- __-_-__ - - `__-_--__ - � _' __-_ - ` ' ' �� � - - ' . ' ` � . ` � ' --_- _' �_-_ �__-____ __'_-_' __--- -_-_��___-- _ ' -- -'__- �-_-__� _�_- _ ~-_____ -_ __-' � � � ` � ' � -_ _