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HomeMy WebLinkAboutBLDG-21-000982 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — CITY YARMOUTH MA DATE August 27,2020 PERMIT# BLDG-21-000982 *11= JOBSITE ADDRESS 31 ELLIS CIR OWNER'S NAME ARCHACKI RAYMOND G OWNER ADDRESS ARCHACKI LINDA M 31 ELLIS CIR YARMOUTH PORT MA 02675-1334 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El 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/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 LESTER WADE LICENSE# 4569 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG( ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: (_ESTER J WADE ADDRESS. 23 BOWDOM RD, CITY MASHPEE STATE MA ZIP 02649 TEL FAX —1 CELL EMAIL infota7.ccipgenerators.com 8310N M3IA3H NVId #1101N3d $:33d ❑ ❑ iIWa3d 3H1 SV S3ALI3S NOIlv011ddV SIHl oN SeA g310r1,4101103dSNI 1VNId AINO 3Sfl 210133dSNI a0d 39Vd SIHI S310N N01103dSNI SVJ H0flOa MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -1-' CITY I &( I O U V� MA DATE I "` 12 A 120 1 PERMIT m 44x-N - oy - C0 '' •(/)\) 4—. JOBSITE ADDRESS �1 E(AAA O i r C Q OWt ER'S NAME , r&Q iR-i2CN(1 Cif I tr I y ',CI OWNER ADDRESS ( Sta.. cti.bo\te- TE 5O8) 2.440 . 001 JFAX 3= ,;_,.�, OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL 11 RESIDENTIAL CLv, v NEW: RENOVATION: 0 REPLACEMENT. ❑ PLANS SUBMITTED: YES ❑ N0 APPLIANCES 1 FLOORS- 8SM LL i 2 3 _ 4 5 I 6 7 8 I 9 10 11 12 I 13 14 BOILER ;- -- i7 --11-"•-� k- y - -_s______� r-_.._ 1. -_,I ��___ , • r I. ;! :f BOOSTER ' II(-"__._ J. �4----ir----1-----r---7:� __ - F-CONVERSION BURNER r-.__ F.`. _.� . t,�.... _ 11 ► �_____ i_.�. [_--. ___ _�A_._.._:�. _._ COOK STOVE _-=- i _:L.�__ •_____.. ce_ �i f� _ DIRECT i• sf fi :I U It .._._. �'_: e_,, - Il _ i E T VENT HEATER -_. .-----.�___—,, •.I-1 IL 1 _; ' , ' ..,,�=•^`C—_ DRYER -.-...� 4 c ..2: _....I!• �l II .. .-._.. I..._. 11 _Jr1....7-j---j,_ ;=_ _ ,�.FIREPLAC . ._ ,,____...�;—• :1 r ,�.�_. ..-_ _ :.r.c_ LATOR t .I^ - � ___ t________ _____, r� •�.' il 4_ :� FURNACE 1'_. __ -----" • ___ .fI_��`' h_-_ i .�._.: _. ..- -,- .i. GEIdERATOR , � �;/i. .4'.� _Ii.mo. ;t .__:.��ry :.. . ..- f. � r _ �.� _._ fr - - - GR ILL t ; i f i_______ - l ...:.1..�_ _ }�`r :- E I. fl :t 1_ri 1 _I 'I r ii i' INFRARED HEATER ; !�"r`°I (-��-- -7 Y - k � __Y __ ,. _ . - . -LABORATORY COCKS - --:- - ; MAKEUP AIR UNIT Ir .:1 it i '— `—' IL, - ---L1----- -I ----fit iI . . . .�Ji =. 0 _ . OVEN #I u _ 'd 3� . . . _ _ �{ _. _ If POOL HEATER I �� ROOM I SPACE HEATER ( -- I I ._-= I ROOF TOP UNIT I1 Y �1. ` I .�..��_• `1 _____'i L.i _ _._..: _,, • , TEST i �+ 11 �' �1.. ` '�-�l j 'I f .t," _,_— UNITHEATER ..... ._ Z. .r•r •.,.,,�...,_f �, ..,�..�: s ..__1 4: r._..�....,.,.. . UNVEN I ED ROOM HEATER ,., ,( 7. ' ...,._=! =fir . '? :,., . - 1.. �•:1= - i 31 �� 1 SWAT ER HEATER i.....,H., 7I .._ - ifs : w 1 ___•;1 �:t _ �t; ! :: - 0 OTHERt'F-711,-----ii _._,r---7 == _L__.__.... � , 4 _ 1 L CI it , 1 _ -1 __�__,. ,b . _4I -- Ti 1 ;t :a ci �' t !• _ _ il— 1 `11 ___ I; ' _i ._. II _ . . II 11 . ...ii-..,.. :� _ ;:-....._.._1L ..s! • . . " L.. r_ , - i ......__.._..._ . , t __-_.i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements oi• iitIGL. Ch. s42 YES L i0 17 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY fl 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. CHECK ONE ONLY: OWNER Ti AGENT LI 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 co plianre with all Pe ;'vent p ovision of the Massachusetts State Plumbing Code and Chapter '142 of the General Laws Or PLUMBER-GASFITTER NAME Le54cr- Vol elet C., LICENSE # S(Opj SIGNATURE MP - MGF IV JP El JGF fl LPG' 0 CORPORATION 74 PARTNERSHIP[ 4 LLC E4 COMPANY NAME:bye, Lee( Xi.vi. eaten÷ pekkopp,Essi 3 &oi,uete 41.1 P.. _€. CITY Ma.si, e e___ STATE I MA ZIP Oo , tic/ TEL 1508',40-2— ' 7 FAX ] CELL3SV - EMAIL1 C�, Cc.' ip vvr� r ► �- �•, , kE c E 1 v E til AUG 27 2020 BUILDING DEPARTMENT By.-