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Home My WebLink AboutBLDG-23-004264 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 1. CITY YARMOUTH MA DATE February 01,2023 PERMIT# BLDG-23-004264 JOBSITE ADDRESS 11 HORSE WAY OWNER'S NAME RODTS PETER B G OWNER ADDRESS 11 HORSE WAY SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ 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!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 ❑ 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❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY COTUIT STATE MA ZIP 026352702 TEL FAX CELL EMAIL info(d,ccipoenerators.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 v •CITY t CC.v'r�-o t�.f4-ter-5� MA DATE ' , y PERMITS Za' JOBSITE ADDRESS I( e Wad OWNER'S NAME ?ei4e-4'G OWNER ADDRESS *SI CL. ab0 VC. TEL�o S-31 7-1$1 a--FAX TYPE T OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL CLEARLY 'NM RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 21 APPLIANCES Z FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 i2 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR ✓" GRILLE INFRARED HEATER LABORATORY.COCKS MAKEUP AIR UNIT POOL HEATER ROOM!SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current If ahilitensurance 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 certfythat a9 elite deans and information I have submitted or entered regarding this application am true and accurate to the best of y knowledge and that all plumbing work and lnstaltatiorts performed under the permit i-s ied for this application will be in compliance all P " on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASH I ith;NAME LfS -€r Uikt etc- LICENSE# 4 5,i SI RE MP❑ MGF® JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME Cap Q_rut+cp ce-v.pyecr d? ta.4.,La- ADDRESS a3 an4:vAV R CITY OAetSkp-P,P STATE AM ZIP cr1 Ito 41 TEL —VS S FAx tt?0A CELL 5n-150--fees EMAIL 1114. CD ce- e Cse.fr1e_4,--a-Far,es. cc.m