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HomeMy WebLinkAboutBLDG-23-001240 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I1ta CITY YARMOUTH 7 MA DATE September 07,202 PERMIT# BLDG-23-001240 • JOBSITE ADDRESS 6 WILSON RD -I OWNER'S NAME COLEMAN JOSEPH G OWNER ADDRESS COLEMAN JEANNE 118 SHEFFIELD RD WALTHAM MA 02451 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES =LOORS 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 1 GENERATOR 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 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. S GNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered-egarding 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave. CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherine a7coastalohc.com S310N M3IA3?J NVId #111N213d $:333 ❑ ❑ 11INH3d 3H1 SV S3AH3S NOI1VOIlddV SIHI ON saA S3 LON NOI103dSNI 1VNId VINO 3Sfl 210103dSNI dOd 3OVd SIHl S310N NOI103dSNI SVO HOf1021 s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK C `"5:3f= CITY: Yarmouth MA. DATE: 09/06/2022 PERMIT# 0 -- JOBSITE ADDRESS: 6 Wilson Road OWNER'S NAME: Joseph & Jeanna Coleman GOWNER ADDRESS: P.O. Box 1266 S. Yarmouth MA 02664 TEL: FAX: 0— TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL �-�/ PRINT '�° CLEARLY NEW: E] RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES „ NO APPLIANCES1 FLOOR Bsmt 1 2 3 4 5 6 7 8 r 9 10 11 12 13 14 O BOILER BOOSTER4 i _ _ CONVERSION BURNER ✓ COOK STOVE DIRECT VENT HEATER '� DRYER . . ' `� FIREPLACE 5 FRYOLATOR FURNACE V GENERATOR ` GRILLE INFRARED HEATER 'i LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM /SPACE HEATER J ROOF TOP UNIT ' TEST - . _ :2 UNIT HEATER t j UNVENTED ROOM HEATER ` WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES VNO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY cil OTHER TYPE INDEMNITY ❑ BOND 0 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 ❑ AGENT ❑ 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 ail Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. % _ � PLUMBER/GASFITTER NAME: Troy Gilbert LICENSE# 13573 ( NATURE COMPANY NAME: Coastal Mechanical ADDRESS: 21 L Fruean Ave CITY : Yarmouth STATE: MA ZIP: 02664 FAX: TEL: 508-737-8747 CELL: 508-850-6955 EMAIL; Katherine@Coastalphc.com MASTER' JOURNEYMAN 0 LP INSTALLER ❑ CORPORATION ❑# PARTNERSHIP ❑ # LLC # 4350