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HomeMy WebLinkAboutBLDG-22-000216 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R 7=, CITY YARMOUTH MA DATE July 13,2021 PERMIT# BLDG-22-000216 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:❑ 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 FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _ TEST 1 UNIT HEATER _ UNVENTED ROOM HEATER _ WATER HEATER 1 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 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 Ilisana coastalohc.com 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 FOR A PERMIT TO PERFORM GAS FITTING WORK T CITY South Yarmouth __ I MA DATE, 07/13/2021 I PERMIT # tSCDC- ZZ -cool_ic. JOBSITE ADDRESS 23 Winsome Road I OWNER'S NAME Steve and Tracy Post _ _ G , OWNER ADDRESS Same I TELFtFAX TYPE OR OCCUPANCY TYPE COMMERCIAL[1 EDUCATIONAL RESIDENTIAL77 PRINT CLEARLY r—' NEW: RENOVATION: L. REPLACEMENT: v i PLANS SUBMITTED: YES Li NO APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER I f COOK STOVE DIRECT VENT HEATER �_ u__ 1. ...3 if DRYER FIREPLACE s } _ . FRYOLATOR FURNACE ---- ..-i' L:-.. - - r----- i .. GENERATOR r---W- r..___ yam. GRILLE L == L._.. Thi— 1... INFRARED HEATER ,t_._ _ !i_.._..., . h.—NJ LABORATORY COCKS .. ! __- _r 1111 MAKEUP AIR UNIT 1 1 _� OVEN — f— — �1 POOL HEATER •ImirromIt....- -_ ROOM / SPACE HEATER `' ROOF TOP UNIT � r-. _ i . TEST 1 = _IL_ _ -- 11r.__I UNIT HEATER ,:-�111111111L w _ J ,!i__ __ �.. II NMI �Q UNVENTED ROOM HEATER WATER HEATER 1 fir- 3.; OTHER I . L a _ — j 'tI1 - ---IL INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES , , 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 compliance with all Pertinent� provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /7L%t�(Je ALL- PLUMBER-GASFITTER NAME[Troy Gilbert 71LICENSE #t 13573 1 1GNATURE MP L" MGF t JP —1 JGF J LPGI [ l CORPORATION j# PARTNERSHIP EA a LC El# 50 COMPANY NAME: Coastal Mechanical -I ADDRESS 21 L Fruean Ave 1 CITY South Yarmouth STATE MA ZIP r02664 TEL 508-737-8747 f FAX i---_ 1 CELL 508-850-6955 EMAIL[Iisa@coastalohc.com