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HomeMy WebLinkAboutBLDG-22-002425 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' 1 CITY YARMOUTH MA DATE (October 27,2021 I PERMIT# BLDG-22-002425 JOBSITE ADDRESS 33 COVE RD OWNERS NAME GRIMES TIMOTHY J TR G OWNER ADDRESS THE CAROLYN F GRIMES IRR TR 505 TREMONT ST#403 BOSTON MA 02116 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY BOND ❑ OWNERS 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! El CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(a.efwinslow.com S31ON M31A3H Ndld #JJINb3d $:33d ❑ ❑ II1V:13d 3H1 SV S3A2:13S N011vUllddd SIHI oN saA S310N NOI1O3dSNI 1VNId AlNO 3Sf1 2:101O3dSNI 210d a9Vd SIH1 S310N NO1103dSNI SVD HOnO J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK T- ; s. • '�="-1�ts CITY YARMOUTH MA DATE 10/15/2021 I PERMIT # JOBSITE ADDRESS 33 COVE RO_ _.„._ ____AD, WEST YARMOUTH, MA 02671 OWNER'S NAME 'MCPHEE' ASSOCIATES/ GRIMES 1 GOWNER ADDRESS _ ____ P.O. BOX 799, EAST DENNIS, MA 02641 TEL 5083852704 I FAX ,� TYPE OR OCCUPANCY TYPE COMMERCIAL 71 EDUCATIONAL :n RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO 1 APPLIANCES Z 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 1 iN GENERATOR � 'GRILLE 449- INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT • OVEN s- POOL HEATER , k..) ROOM / SPACE HEATER ROOF TOP UNIT � TEST _ It\ UNIT HEATER __ UNVENTED ROOM HEATER WATER HEATER _ OTHER c`{ • INSURANCE COVERAGE in I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ' v NO C I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v] OTHER TYPE INDEMNITY BOND c"4! OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the ill 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 true and accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc I a P rtine provision of the Massachusetts State P umbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE #: 12298 SIGNATURE MP MGF D JP JGF Ej LPG/ CORPORATION # 3281C PARTNERSHIP # __ LLC , # Q ...._Li I COMPANY NAME:$ E.F. WINSLOW PLUMBING & HEATING ADDRESS ' 8 REARDON CIRCLE 71 CITY ! SOUTH YARMOUTH '1] STATE MA ZIP 02664 1TEL 508-394-7778 FAX 1508-394-8256 CELL)N/Aµ EMAIL INSPECTIONS@EFWINSLOW.COM