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Home My WebLink AboutBLDG-23-005315 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK V `1 ", CITY YARMOUTH MA DATE March28,2023 PERMIT# BLDG-23-005315 n , �% JOBSITE ADDRESS 717 WILLOW ST OWNERS NAME PEARSON DAVID T G OWNER ADDRESS PEARSON THERESA M 3440 AUSTIN CT ALEXANDRIA VA 22310 TEL _I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:D 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 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE 1 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 ❑ OWNERS 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 at plumbing work and installations performed under the permit issued for this application wit be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME (Kevin Abbey I LICENSE# 12357 SIGNATURE MP 0 MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'ABBEY PLUMBING&HEATING I ADDRESS. 1596 Queen Anne Road, CITY Harwich STATE MA ZIP 02645 TEL FAX 5084308462 CELL 5083670437 EMAIL abbevolumbingWcomcast.net 1 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 . , MASSACHUSETTS UNIFORM APPLICATION rum m rcrsivn, I v 1 11.••1 • -••- •A''- MA DATE W. a3 I PERMIT# AR 2i932fri3ADDRE0SI 717 1i,)jtL4�. 61 'OWNER'S NAME I p£ftg_son _. OWNER ADCRESS I iTE`i 1FAXI - BUILDING DEPARTMENT TY ED- PE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL®' PRINT PLANS SUBMITTED: YES[] NO� CLEARLY NEW:[—' RENOVATION:E/�� REPLACEMENT: APPLIANCES Z FLOORS-, BSM 1 2 3 1 4 5 6 _ 7 8 _ 9 10 11 12 13 14 BOILER f, l r� _ BOOSTER _ _1 CONVERSION BURNER 'r IL —"'L �`` COOK STOVE . li IL_._ DIRECT VENT HEATER DRYER 1 , _._ �.. FIREPLACE E. l-- it -" = FRYOLATOR FURNACE I___.._. _ ) 4___ —_ GENERATOR _ — =_ GRILLE L__ INFRARED HEATER I. ..�_ I 1 -_ -- LABORATORY COCKS _, i -- MAKEUP AIR UNIT Li__ ._. OVEN (-_... Q POOL HEATER ROOM 1 SPACE HEATER -ir= om.; ROOFTOP UNIT ...-11-..._ — — TEST I ,�_ --- r-__. UNIT HEATER Il.. _ ' UNVENTED ROOM HEATER I - l WATER HEATER i -- OTHERII— INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I 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. CHECK ONE ONLY: OWNER. AGENT 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 complia ce with all Pertimt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � 4� • -/+ PLUMBER-GASFITTER NAME, iw,,n ABgZ� _ I LICENSE#I1 3S7 SIGNATURE MP LAMGF F JP 0 JGF D LPG'❑ CORPORATION D#I —' PARTNERSHIP:14 . 1 LLC 0#7 COMPANY NAME:I ASBEY 964 1ADDRESSI 394 asscn Amu. (�oAa --..__..-.-_- 1 CITY i rTRKuJ:c rl - I STATE AV- ZIP ifs--._ . TEL I- S�O3 ES - 67- 0 L/3 7 I FAXI ICELLI 1EMAILI /IJ3 BPI).1PLv f3Ih e CQc-i f s.-r. /Ixr 1