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Home My WebLink AboutBLDG-21-005105 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k,e � s BLDG-21-005105 CITY YARMOUTH MA DATE March 09,2021 PERMIT# JOBSITE ADDRESS 73 WEST YARMOUTH RD OWNER'S NAME OSULLIVAN JOHN P G OWNER ADDRESS MEHEGAN CATHERINE 73 W YARMOUTH RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 FIXTURES FLOORS—4 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 GENERATOR 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 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF 0 JP El JGF 0 LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX 1 CELL EMAIL stinger.mcbride@gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES (, • _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "1 L CITY y� .____- .ep . - ' 4 ( MA DATE PERMIT# b.LbG- z(- 40°A 0r JOBSITE ADDRESS 3 W. -- o� 4 j OWNER'S NAME-VI/1S(� /j€ 1 GOWNER ADDRESS i 5 7 Y J TEL7/7 .Z30 1FAX 1 TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL..,1 EDUCATIONAL J RESIDENTIAL 74 CLEARLY NEW:.14-- RENOVATION:J REPLACEMENT:/L PLANS SUBMITTED: YES iJ NO_[ APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER __J__I__I___I__J-_J_I J_J_I_1 .I__J____I BOOSTER _1 I I I "_1__J J_I__I.-1 —1,-1--I CONVERSION BURNER I 1__I I_l !. I 1 _I__II_1____J_I__J _ OOK STOVE _I I�S. I . . I_I— --J 1__J —J J—J J._1 DIRECT VENT HEATER __I—1 I J. 1 __J I I _I _ I DRYER• ]J_I___I.___J�, —J ___JI 1 I 1 .._ .I _1_____IFIREPLACE -- � . ._-____.1,_ I FRYOLATOR , -_J—J.__1._-1 1 1 _I___I_I � ___1 J_1 FURNACE ___I_-J__I_I I_J_____I 1 __} I ► ._I _____1 J 1qi-GENERATOR 1 I I LL i I, I�1^I J_J__ 1 _1 1_—J_._-J _._._1___.J _J GRI INFRARED HEATER —J—J—J —J 1 1 . —1 _._. ..... I_I ___J—J--I—J LABORATORY COCKS �1 _ _.I i I.-J _ 1_1 I__I_____J__-__I____J__I-_J_I____J itMAKEUP AIR UNIT OVEN I_____I. i I- I -__I_ _1_ -! ______1 _ 1 1 I i POOL HEATER _____I_ _ ___._._1_J.____I____ I._-J__ I I J_...�I __.__J_1_,_I ROOM/SPACE HEATER ____! . . r__r1 i I I_ 11 i _. I I I.__._I--._.-I I ROOF TOP UNIT ___I , ; '—_J___._I �I I____1 —I �J -_J—.I_J TEST � 1 1 _._F IJ i I ? I I I UNIT HEATER _ I I I _ t_ .____2_ _I_._1 i__ ___I I__._-J 1 _.1 UNVENTED ROOM HEATER I__I I ��I—. 1 1 J {____J______I_I_____1_� ____J J WATER HEATER _ / I I 1 1 I _ _ 1 ...__._ 1 _^J_____J 1 ,_J__I OTHER I I__I I. I I I I __._1__J___J—I _►_ __J ' . - _ I I _ I I_i I-J,J __I i_J __J-J_ 1 I 1- 1__U___._J .. ! .1 I I_.-J __ I-J_ _ ______J: I ! 1 1_ ! _...I ! �_I-__--1 1 `I I_� i, t INSURANCE COVERAGE 16%C I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES [NO J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i ( OTHER TYPE INDEMNITY `J BOND IJ 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 '_I AGENT J 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 pliance with all Pertinentipro vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7 -� PLUMBER-GASFITTER NAME ( LICENSE# 7�� SIGNATURE MP J MGF'_ JP - JGF LPGI __.i - _ -- _--'1 �1 _� J CORPORATION �#'�� PARTNERSHIP-._# � LLC �#' COMPANY NAME C I ADDRESS /42_,0.57-76_, jr/ite 1 CITY Vi _ /"� .1v 1 STATEM ZIP 10 Z.(p7 TEL 7_ 77 g d -✓T 2z: FAX I CELL; ' -•'`