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Home My WebLink AboutBLDG-22-000885 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH LMA DATE August 17,2021 PERMIT# BLDG-22-000885 Lis , JOBSITE ADDRESS 23 WINSOME RD OWNER'S NAME POST STEVEN C G OWNER ADDRESS POST TRACY A 23 WINSOME ROAD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ 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 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE , INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP El MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 — TEL FAX CELL EMAIL lisa[7a coastalphc.com S310N M31A321 NV-Id #1IW213d $:33d ❑ ❑ IINIU3d 3E11 SV S3Ai13S NOI1VOIlddV SIHI oN saA S310N NO1103dSNI 1VNId AINO 3Sfl N0103dSNI?JOd 30Vd SIH1 S31ON NO1103dSNI St/0 HOfl02J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t� .t , 7 ..3 CITY South Yarmouth MA DATE 08/16/2021 PERMIT # '- i - C.i F JOBSITE ADDRESS 23 Winsome Road OWNER'S NAME Steven and Tracy Post GOWNER ADDRESS same . . ITN ' FAXL TYPE OR OCCUPANCY TYPE COMMERCIAL 71 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: i RENOVATION: REPLACEMENT: r 1 PLANS SUBMITTED: YES NO APPLIANCES -1 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 AIL AMP 401111111110. ; GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 1 ,,imr.. mat' POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER i �........... ... �,....w.__,_.....,-„_-__ _ _ .xwrr.. ., INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ri NO El I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /t /de _ PLUMBER-GASFITTER NAME Troy Gilbert LICENSE # 13573 SIGNATURE MP MGF EI JP ® JGF 0 LPGI CORPORATION ' # PARTNERSHIP #' LLC # 4350 COMPANY NAME: Coastal Mechanical ADDRESS 21 L Fruean Ave CITY [South Yarmouth 1 STATE MA sZIP 02664 3TEL 508 737-8747 FAX CELL 508-850-6955 -"EMAIL' lisa@coastalphc.com