The URL can be used to link to this page

Home My WebLink AboutBLDG-23-002773 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 17,202;PERMIT# BLDG-23-002773 'l l JOBSITE ADDRESS 3 HARBOR RD OWNER'S NAME NELSON CHARLES J G OWNER ADDRESS NELSON BEVERLY S 22 NORTHERN AVE BEVERLY MA 01915 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 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 ❑ 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 Charles Nelson LICENSE# 18271 SIGNATURE MP❑MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: CHARLES J NELSON ADDRESS. 22 NORTHERN AVE, CITY BEVERLY STATE MA ZIP 019152841 TEL FAX CELL EMAIL bevinbev(a,msn.com et l ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES f5 ,W - '�'""- SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �_y, CITY P )14.417117-# MA DATE 1 1 — C7- 220- PERIAT tt • N�V 17 =SIT A DRESS -Z [1Od-b CI— Kb OIti�I�ER'SN.o,ME � �S F(S 5e DUIL U pE��AD F,ESS TEL FAY, PRINTOCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDEIJTIA CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT PLANS SUBMITTE YES I "�' APPLIANCES -4 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1': BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 —_, DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER _________ LABORATORY COCKS `— I 1 ,�_ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST ' UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER L— 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 COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY 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. �' �' + 7d 5� CHECK ONE ONLY: OWNER •� SIGNATURE OF OWNER OR AGENT AGENT El ' 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 Pe 'vent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `1 r PLUMBER-GASFITTER NAME LICENSE# 9147a SIGNA URE Iv1P MGF El JP ❑ JGF ❑ LPG! ❑ CORPORATION ❑ i PARTNERSHIP❑# LLC❑ COMPANY NAME /f& e L.bI., ADDRESS - (4 Ctrscl-, TQA CITY I<'L,/. v r./' If (J ! )-f- STATE- f "1. A ZIP 0 Z �G7� TEL 7 5-2_ Q-- CELL?7 -- C' I E. 1 &EMAIL be-‘,/IA: 6e-Y C ','1 S/i,' e ac/ " CL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yeas No THUS APPLICATION SERVES AS THE PERMIT (_I FEE: $ PERMIT { PLAN REVIEW NOTES _---- •