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HomeMy WebLinkAboutBLDG-23-002444 s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH w UMA DATE November 03,202.PERMIT# BLDG-23-002444 I I JOBSITE ADDRESS 29 VALLEY RD OWNERS NAME PARKER EDWARD P TR G OWNER ADDRESS THE EDWARD P PARKER TRUST 29 VALLEY RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:D 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 1 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 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 0 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 I LICENSE# 13573 SIGNATURE MP❑MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: 'COASTAL MECHANICAL I ADDRESS. 121 L Fruean Ave, I CITY 'WAREHAM ISTATE MA ZIP 025711324 TEL I I FAX CELL I 1EMAIL IkatherineA.coastalohc.com I 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 r=.{ = -_' =- CITY [Yarmouth W MA DATE _11/142022 PERMIT # 21- 'Z�1 y`i s. JOBSITE ADDRESS 29 Valley Road OWNER'S NAME Kings Enterpise LLC GOWNER ADDRESS 24 Namaschaug Landing Spofford NH 03462 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ._J RESIDENTIAL PRINT CLEARLY NEW: _ RENOVATION: i REPLACEMENT: PLANS SUBMITTED: YES Q NO.,, APPLIANCES Z FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 I 1 I ;( ! - ! BOOSTER - I I _ i MN NE CONVERSION BURNER ® —1MIMI. COOK STOVE EN 1 __... .1 ___ — I=I 10111 DIRECT VENT HEATER i__ _I -_. =- I I 11111111111 DRYER 111111 FIREPLACE _ � � r- ® i , . - .._ I I II I I 711.11 FRYOLATOR � � � ����� MIME mall i III MO MI MEI MINI' '111111111=1 LABORATORY COCKS M-11M11111.111111111111111111.10MTIMIIMINE ME ME MAKEUP AIR UNIT M1 IIf I111•11 IIMMlairM If_1f_II II I OVEN ( '; f III 1( III IIiII II II ,III ,I 1C�l POOL HEATER nis ROOM / SPACE HEATER ROOF TOP UNIT MIN IMIIIIIIIFMM EMI EMI NON INN NMI NMI MS TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _ I i OTHER I, 1 1 m I 1 I f l I I r 11 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [ i j NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I i 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 [1 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. �2B ydeeAL- PLUMBER-GASFITTER NAME Troy J Gilbert I LICENSE # 13573 staiATURE MP DE MGF JP Li JGF LPG! CORPORATION j# I PARTNERSHIP LJ# .1 LLC [j# 4350 COMPANY NAME: Coastal Mechanical ADDRESS 21L Fruean Ave CITY Yarmouth STATE MA ZIP 02664 ]TEL 508-737-8747 1 FAX 1 CELLI EMAIL Katherine@coastalphc.com