HomeMy WebLinkAboutBLDG-22-004869 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE (March 03,2022 I PERMIT# BLDG-22-004869
"s JOBSITE ADDRESS 101 WIMBLEDON DR OWNERS NAME LOWERY MICHAEL C
G OWNER ADDRESS LOWERY KATHERYN K 39 LONGMEADOW DR DELMAR NY 12054-2325 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El
PRINT
CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED:YES❑ NO 0
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
LABILITY 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❑MGF 0 JP❑ JGF❑ LPG( ❑ CORPORATION❑# PARTNERSHIP ❑A LLC 0#
COMPANY NAME LESTER J WADE ADDRESS, 22 CAPTAIN ISIAHS RD,
CITY COTUIT STATE MA ZIP 026352702 TEL
FAX CELL EMAIL
S31ON M31/132! NHld
#IIW213d $ :333
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\ k ASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT T TO PEi,_FOR;,GAS FITTING WORK
i CITY \ L I7 1 MA DATE I a-�4-3- 7 PERMIT#
JOBSI T E ADDRESS I I e I III?I rK b tf A.o vi br• I OWI;tER'S NAtvME (1A,i- (-o WC._r ii
• OWNER ADDRESS 1 Spa. cLbovG ITa It-`i`iI-?5y-a lF'J'i I
4 OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL [I RESIDENTIAL 1
Cf :�-.;r-;.V Jr-' PLANS SUBMITTED:ED: YES 0 NO
i •
NEW:tXf RENOVATION:I_ REPLACEMENT.❑
APPLIANCES 1 FLOORS-1 I 9SI,t ' : i 2 I 3 I 4 _! 5 6 1 - 19 ,l- -_i :.Ir f 1i f #? i3 jd ,
4 ._
E`C•iLEr� ` :'
_ ., , - I-_^-�—-= i^—-ice—r r_.._ c i4y l ..
— -
:
CONVERSION BURNER It. -'if5- - r it —J -- -rr - i;
! r
:
— _ ___ ,. ,_.
_.w-n
COOK STOVE il
i .
�- '
DIRECT VENT HEATER i #I u } ' -� i _! ± .. , '- '
DRYER f- —� - f -' -i . _1 . - -._a� � _ _ ¢_ _- ,,,,.!...-.,....i
FIREPLACE li _ ' - � - i� S' II ---
.mot= - - ,_,m,--3 .,- , f�-_-z.,�- }- -` *'- -i'"�
FRYOLATOR r,. 1..1- �- TI =I-- -- 4�-,�_-' j;.-_ -,
- ,r---- �r h t,. :,
FURNACE i1.... ii :. i.. . - ::� __ _ � �- ;_ ,- ;...,
GENERATOR ✓ E —ri ,_-....i' . - •_�
--- 1 1
GRILLE
INFRARED HEATER a ;l I'. )t : I__-�_. - - :,-__ __-f. _
LABORATORY COCKS —ram — ` ?
' , II a ' ' -"':_`'_`r=-` --,`i, '!
I p
MAKEUP AIR UNIT ii ;I —u .' ii ,,,:1t.K_ i. .l i�—i u
OVEN 1(�- . - --= '; _ ,I ,l -. -}_-i:��T�1.=-- , -..=_. z
iu_=: t - .� _ram _.q�-.,. � �POOL HEATER F I__ ._ t
ROOM I SPACE HEATER N it .4- _' �`�-iI != - - �`rT
ROOF TOP UNIT 4?-21 r-^I -;�- : -
UNIT HEATER - ;! _� 4 -t 'I '- •_-I.UNVENTED ROOM HEATER 1I �-H
.
; -� � i . ��,:`�s. L-..e. �-,> ,
!WATER HEP.TER = == - —:, ! �•._..;
OTHER l .4 _._.�a __. ! '_• =
-il
0,
--- - - INSURANCE COVERAGE
:nave a current liability insurance policy or its substantial equivalent which meats the re_!uirements of IvIGL.Ch.11.2 YES 1;!0
I IF YOU CHECKED YES,PLEASE Ii4DICATE THE TYf E OF OJVERAGE BY CHECKING THE APPRO'RIATE BO::BELOW
LIABILITY INSURA\ICE POLICY a/ OTHER TYPE INDEirii'!IT`( � BONl.; ❑
-I OWNER'S INSURANCE WAIVER:I am aware the.the lirensee does not have the insu anc:covers ie required by Chapter 142 of the
iulacegrhuse General Laws,and that my sign ture on this permit application waives this requi:•ement.
CHECK O1.E ONLY: OWNER 0 AGENT
SIGNATURE OF OWNER OR AG IT
I hereby certify that al of the details and information I have submitted or entered regarding this application are true and accurate to the best of mf ltnowledge
enc that ell p:umbing wort and irsaUatiors parfotmed under the permit ssead lot this eppli�tion'Ali be in co: plierr.e wlth all-,doer:provisicil of the
Massachusetts State Plumbing Cone anti Chapter 142 of the General Laws , OCC t
PLUMBER-GAS FITTER NAME 1 Les4c-- ikitt t e, !LICENSE T1�{'5(09 j SIGNATURE
MP❑ MGF JP ri. JGF 0 LPGI C CORPORATION( I#I I PARTNERSHIP❑ � I LLC D f
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C&p� f tliz�% t, '.ESS 123 &���(te O., 2.i. 1
C,CiviPE; lY i t+tvit (,p
CFi JvlaSL4pee_ I STATEIMA !DPI OZ.(it f ITE i55or-e -i-rT.3'7- 1
F.6.x..i 1 CELL yes- -�- iEF?AIL: t4b Ct'. Cc-.p t•vtir--C a r•s . c a:+� t