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HomeMy WebLinkAboutBLDG-23-000544 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH —1 MA DATE August 02,2022 PERMIT# BLDG-23-000544 JOBS TE ADDRESS 31 HARDING LN OWNER'S NAME Anne Mingolelli G OWNER ADDRESS 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 1 i FRYOLATOR I , FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER 1 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION[]# PARTNERSHIP El# LLC ❑# COMPANY NAME: [\NDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanvna.amail.com S310N M3IA32J NVId #1IW213d $ 333 ❑ ❑ 110183d 3H1 SV S3A213S N011VOIlddV SIHI oN SBA SRION NOLL3 dSNI 1VNId ,LINO 3Sfl 210103dSNI 21Od 3OVd SIHI S31ON NO1103dSNI SVO.HOfON A60 , _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK aulil ' CITY I.. c- ",.Y4 eyt b MA DATE # L 3 o S- �r c y -= e - _� - _ ., CT .r. g PERMIT i AMITE ADDRESS 3 I H - - i ________--- , v! OWNER'S NAME i'1r1 JijJiTL[JII1.G OWNER ADDRESS L ° ":a:,..c.� :.:r..:rs��c .Y• �.:_�-_�_�. ..._ .. ITE4/7zj1FMrJIHJr4 TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL 71 EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: L.i REPLACEMENT: D PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-. 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER J :i BOOSTER is 1 I. - . -r- - - � _ :: _::.. � ,..� {ff. i _y �..:.�,r-...a�.-r!.�--.�..:-. _a-.._�., .cry_.....- ....__.,__. ...r-...--__.•'.:r•..:�, r-s.cs�.cr. _x._ .ri= - - `V_� CONVERSION BURNER -`" f — -= its = �;�� ? `,�— 1- i COOK STOVE f— = .fi DIRECT VENT HEATER -.�n•: ._ !,. ' __.- DRYER # _ i _ , i s r { - _ 'En_ :e 1 t FIREPLACE ' T . : _ -f �. �.,.f : T , FRYOLATOR -�! I_�_ _. s I FURNACE �£ - _ ' — - '. - _ l`.r_�s 1--= t �_�,—,...._._... r GENERATOR _ Jri_-7 .�� "r . .. = GRILLE _ :(r�1y-? <A_.wY. -- . i 71ffin �� f xr i ii .. b' INFRARED HEATER !!k _ ' ,�__�, LABORATORY COCKS _- MAKEUP AIR UNIT ; _ • ' - l� ` -t`+rw•„r�• - 1- •• - _ _:E it 1' ' • ••1r.,.- -] OVEN !-� ; . :.. �.� _ ._ rs. �.. �,�:.r, f rr �r t -L{ �__li �' ;S �-- so- �: ` —'`' '' �` ::� `';:c -.. _ f ` - ! a. -i .TS�irT 4 POOL HEATER - �: _ 1,_ - -1 �.1 ' >_„„� ._sue- '' +�+..,r� , _ ,..;.;.a..i • - ROOM/ SPACE HEATER _.^ _� It �, -`-� ;( IT _ �: - I . . ROOF TOP UNIT ------- -�-- =...r�_ .__.. ._ ,.-:-_- ... .. TEST -��-� - �. c�rw�.�_�..,�-:, UNIT HEATER �-;...�_._. , ,�....�,.:� �-: . - ----, r-----..:. . . UN1fENTEO ROOM HEATER -.� -y`1: i'._ :}. Y -.,V� # —_ _ WATER HEATER .: _� ( . t —_—_. .._.._....._ 1,...„_, . ._ _ • _ .. ^. OTHER - - - ; r_.,:.____ ..., . wantiii .... ,iwwwwwi imp _fm-____ i i ,___, .1 _ .„;- _ . .: , inn__„-,. _..., . ..- ..,c----' o,,, -,-- . ..., --T. 1'..-- .1 ..--. t .-., •- 1.,. --,-,‘ •.I.c., - - - 1..1.. •-�..- -..._. • ! f _ f ! INSURANCE COVERAGE have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Of0 LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Li BOND Li OWNER'S INSURANCE WAIVER: lam 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 Lj AGENT _.1 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appficali are truand curs o the st of my knowledge and that all plumbing work and Installations performed under the permit Issued For this application will a In comp ianc with Pertin t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i r PLUMBER-GASFITTER NAME �j� Nc.� ' 6/1 i 1 LICENSE # ic__ ,:� SIGNATURE MP „�' MGF Li JP FA JGF 0 LPG; ,V I CORPORATION # s) L,' C. PARTNERSHIP(11# LLC # --- COMPANY NAME:[ OIGC.'f _ 4"'LFe._ j ADDRESS 1.9_T_, 72 ,3 % CITY _.c 1 ` 1 . : S STATE JLf/;ZIP C2L & C- TEL ica- ' - 3 a-3 ( i EMAILFAX,.Q��.�...f'G..... L�� CELL � e7--b,/,/,�//, coy-4' ,1••••••_ , . . „ _ _ _