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HomeMy WebLinkAboutBLDG-23-005338 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 6 CITY YARMOUTH MA DATE March 29,2023 PERMIT# BLDG-23-005338 JOBSITE ADDRESS 53 WHITE ROCK RD OWNERS NAME STEVENS CHARLES L G OWNER ADDRESS STEVENS DEBRA L 53 WHITE ROCK RD YARMOUTH PORT MA 02675-2314 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO El 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 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 ❑ 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 Craig Bishop LICENSE# 115101 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: (HIGH EFFICIENCY LLC ADDRESS. 378 Route 130, CITY Sandwich STATE MA ZIP 025632342 TEL 5088253695 FAX CELL EMAIL salessupport(a high-efficiencvlIc.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 EC1 \Ir a 2 zo23 u MpR 7 1 1 .g ILD�N . D.PARTmEt'!T By' ' - • F ETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS. FITTING WORK � _ � p LAa CITY ; 1 , V t MA �ATE' ,.,, P " • - - - JQBSI I'E ADDRESS . OWNER'S NAME ' ,_,..- t7ER ADDRESS s,,�.rr•�-� �, ,r..+l . ei�bmG,�d.I>�! �Asitdtr rry vw- , �('r,(j'`p�( »+� • .>r.- sfa• --,-r: err I' T OltOCCUPANCY TYPE COMMERCIALQ lUCATIONA�, ( 11 RESIDENTIAL - Cx' NE\N:I" RENOVATION:U REPLACEMENT_E6 PLANS SUBMITTED: YES `` NO I,'I v,hY APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 4 7 8 9 10 11 12 13 14 • , ' . .._.`I ,,. t1 BOILER ` _... ! . _„ d I �'_.�', .�.. BOOSTER �,. ,�•_p�.".r- . ,.M.� [ '_ ... ''� '+ -`111 ill .- ==l ;- 1� CONVERSION BURNER ��.�,� • is IY rr•rrr.rrr.: 7' Y 5....::'! •' I<,+,'.^•rlfi- ' mom- J .•-r. .fir.. ......r-•-r u?i tirrn�.•� _1�•-'-- '! r 'i _ COOKSTOVE ,,nrN rettnM•n 1I• nlrlFMry 5-,-- -�•^-+-1<••_••r ..r•..• 0,...' tr^w• r I,rr.1..i r•^�•••••,•: !•-"• .. .• f DIRECT VENT HEATER '• _._... 1._. .. ' AMU__,r .,,--. w `;' ..,.� DRYER 1 - I .n---- Wig''~ NW ` - .r: a FIREPLACE - ---- -.... F.L...,,KR ,_......_s'�_.... I,.l .�� rMI FRYOLATOR I ___r-!'L� ..__ _ ._. s _,�,Kti�'�J° 1 FURNACE 7* • 'Wli GENERATOR 1t,-•---J — .__.._. ',l �: �, ' - aux r GRILLE .I _.. +il INFRARED HEATER L T_..�r(;" r„..•. 7 ,,..•r-. 1 ' .�-•"-r_ ;•'Y . .,r,.,,,. _,.•_r,r`:•�'r--,1L ., ',k- .: COCKS _ •ll 'I 1 1 y. ...--.•-•-= ...r..rt^ ,� LABORATORY �' ,-...,-, -,.rr..rrr..,- �; '� r _ I t 1 MAKEUP AIR UNIT l-^--- Ai. 7 — .. � --- ,,r ` 'r _ i ` OVEN EN ! t MEI T F 1 _..• .r ....-..-,.r I L• :II •_ r _.. lam' -�- -I.---' r,��� "POOL HEATER , ='�,�. r - . ,rl�,.y._. _._. _s t,..�., : �..,..� ` . ....� .,� �:.. - t, Tr i ROOM /SPACE HEATER t ?. �- ' .. =,r :: _^' '•` _ '�'-"--,4 -•'-r • TESTl.- •: ........._"I =r •I :1,1 •emr--• ...fir)I -.-. ^- —1, _ + ..----r-,/ UNIT HEATER :I-�._+. 5, n>x, •�111C_ ^^^•li ,r'-rY =ry L1 12- 'tlb.I•Tih} .,I r+r UNVENTET) ROOM HEATER {[ 5' -• ' t' r.a,trolA -,T-•- ,.r,r...,..a'.^...rr•w• • rl ..^.: 1• .• —'.�.4rr5.4ro fr.Y-...r.. di r-• - -'wuttl -,.•-•••n,r --- +,-.r-L aLy'• „v ,� p.. .,'•rL-!^l�"•-" I� ...1 ~ 1 1,�---? WATER HEATER ' t A . it _ r_..r• _•— .,.,tw, �� •t i ••_ _.,�. ,,,r_.-�' �._ !' . - -- ,: ' .•_ •.'.I - r OTHERs .,•... ..a t.._.. -• --,t,.,. 1. ..•v... �r« ..,_. z. - r yar..,..- =t' guix1at.ezeitS3:1r.-0.•. ;-•;;7::iC". coute.oYei v.:.i,M.,:. -• �..+-r-_:••^....._ I. .. .. I " .• _•.r..: ..�_;ft." •�"I r' __ OW_..._._..,......__...._......... l r 1 — - ~'' _ rr.-..,..r. - J ... I t`.....--•----•%' I� ." •; ,•k.....rr7n t�..�.. ..-•.-.,,•.•.,'T•.v^`.�...� -- lan-•i:_�.•..�tra.wL..e .ti. ..le.)'t1 ..,.', U n•roe.rr-,^ �,---.•T,,. .1-_--T,-r•", --r.--,-, 1 L.. 7.�i ;�• 7 .w.w..-'- 1 jI Y . J... ..-,r.. t r r1 rmr,r_j yr-••3�� r1.•,...•-•—i .rw.... ...�.1 M^» _ ,.,..•.w.... . .......-v I—.r--h .•...„.,-.—�'1.r.•.,..,.m+r .-„_.....r,-: •....._1 ---? ytt,nr�,.+.ry>" ...,...tr.<h►r�,•rWk•'vnq-^,G,�,:-r.. .,rCrY....7't1777d `��y�� �' r INSURANCE COVERAGE I have a current liability'insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Li, NO F - 11F YOU CHECKED YES, PLEASE INOECATE THE TYPE Or COVERAGE BY CHECKING TH APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY FE OTHER TYPE INDEMNITY 1 1 BOND 171 OWNER'S INSURANCE WAIVER: lam aware thatthe 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 J...,-a AGENT Lr SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information(have:submitfied 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 provielon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, a Cr-""< c-) r PLUMBER-GASFI`.F ER NAME 1Grai B ho _4 LICENSE #115191 3 SIGNATURE ......-?-7 MP MGF JP 0 JGF J LPG'LI CORPORATION I D#I I PARTNERSHIP ,,,j#L.,..,,., ,,...,j LLC 11#?:( 'J COMPANY NAME:iHIRh E#tcien ADDRESS 1578 mute 130 - - . { ISandwich .. STATE i Ma t ZIP 142563 tTEL 1 - CITY I,,,, ..............._ .,.r,-4�_ - t• ......t �,..., .. —. y..�yr._--",._r-.,� •-r'�i FAX 1 CELL ; EM,g1L�, salessupport@high-e iciencyllc,com - a. ..r.--- ;`:\if ' l"""""\ .,„4/1