Loading...
HomeMy WebLinkAboutBLDG-23-002506 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 07,202;PERMIT# BLDG-23-002506 JOBSITE ADDRESS 69 FREEBOARD LN OWNER'S NAME EICHMANN PETER G OWNER ADDRESS EICHMANN JANE 34 RAYMOND ST ROCKVILLE CENTRE NY 11570 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 1 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE:TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El 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 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 El MGF❑JP❑ JGF El LPGI ❑ CORPORATION❑# PARTNERSHIP El# LLC❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompanvAgmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES If‘6e. ---"-------- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING►• , WORK r .w, LI aut;•��_� CITY �/h � ., - .= 1,.__ Kt S,��e _._ MA GATE rl0 2-6, - PERMIT # - '��r47�' JOBStTE ADDRESS _.-F . .. .hØ � ✓I OWNER'S NAME ' _ — j__.__.._....___ (2_,A Gf OWNER ADDRESS = •/ j, • XF TYPE OR F 2/47 PR. OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL RESIDENTIAL f � CLEARLY NEW: , RENOVATION: 0 REPLACEMENT: L I PLANS SUBMITTED: YES f.._ NO APPLIANCE> 1 FLOORS-+ ' 8sM l 1 l 2 3 4 . 5 . s 7 ; s g < <© i 11 12 I 13 14 BOILER --BOOSTER , -. Mr------- `---- -�CONVERSIO�1 BURNER — : .__ _!_ �` _ i.. :� r— { ___ ' COOK STOVE -.,� ;!= f • j_ __`-_.-._r_ :'1. if _ 4I DIRE _ _�— - . - _:., ,r�.. CT VENT HEATER ram. r. F _ i �:.. �, " DRYER _..� . �.�_... ._. __--- _ ► _ . . . -=`� :._.t, r— - — r FIREPLACE _ �� -_ _��_si_ �:�. f :► r.. ' -- a �f.• _f _ _ it FRYOLA1 OR ��._..__ — ,mot__„ FURNACE - - _ /� _ _ _ �j�._}..,.�_ -_.�"�._.. _ 4 � r., l♦i r+'t GENERATOR — —IIIM - i. GRILLE M - : -._ '� _��_ t M ^_. AWN � ' ! ( --= INFRARED HEATER M __ j � } - - j_ /;!_._._._�_ --- LABORATOR"COCKS = `� : t MENIOMMIIINKIEMNISMIMMINIKIIII MAKEUP AIR UNIT _I - i M M .-�tM { OVEN i� ._ •��F_ -�1 ` c°M -r-- : ` ` f,- : POOL HEATER �SK: - _ _ ROOM I SPACE HEATER , - I, ROOF TOP UNIT : - _s _ � e—=, - r-{.---_ �=-=; TEST ...1. _ ~.t KM..� _....i �. • UNIT HEATER i f- ,— - - UNVENTED ROOM H _.�_�=i,.. '- --�_`� _.. .-. �_� .e `� �r---�—=�_ EATER �. {- - _� 1----_ - WATER HEATER -'T� • - 5 w-r � .��.. -- i. OTHER :; V.L r . ! _� _4. . _ i.._____, _ _ _ J....IF!. . , _ . ...mu_ .. i .____. ., ;, _____ , ,____________ :, ..,.,..,„............., .,..,__„.„.., .7: i, . , R,-- fr--- ,imme:Will_____,=L...,.._.1::: ._. '1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch, 142 YES t1 NO L,._, I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND Li 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 an this permit application waives this requirement, CHECK ONE ONLY: OWNER j AGENT _ SIGNATURE OF OWNER OR AGENT ___- I hereby certify that ail of the details and information I have submitted or entered regarding this applicali are trugand cura o the est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will e in compBanc with Partin . tprovisionof th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /' e_ it �"— ~ PLUMBER-GAS;iTTER NAME - �. �-� le-,&Wilc'44 )f 6.�'.1 - i J LICENSE #1uoE - SIGNATURE MP MGF D JP 0 JGF ',_J LPGI L .I CORPORATION # .`' J PARTNERSHIP 1 .1#�v, j t LC LJ# ^Y_ -I i COMPANY NAVE:� c jADDRESSL ' q5 ('77.- '3-5'__ _ , :- CITY L...Eat ___<,.�w r. ..r _-- STATE Lit:eArZIP - &-T._ A TEL € 19 1L 54 3 i FAX 70 CELL _-______ . •, _ JEMAILlic/-7/..---,A .ru =,�r-i9ir�t< Cc�N _j 4