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Home My WebLink AboutBLDG-22-005642 — MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ti CITY YARMOUTH MA DATE April 04,2022 PERMIT# BLDG-22-005642 JOBSITE ADDRESS 59 WEBSTER RD OWNER'S NAME Bernie Walsh G OWNER ADDRESS MA 01824-4300 J 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 -4 BOILER - BOOSTER CONVERSION BURNER COOK STOVE 1 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 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 El OTHER OF INDEMNITY CI 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 Robert Wilson LICENSE# 15509 SIGNATURE MP El MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC El# 7 COMPANY NAME: ROBERT R WILSON ADDRESS. 50 LAKE RD, CITY WEST YARMOUTH STATE MA ZIP 026733743 TEL FAX CELL EMAIL willidoq50(@.icloud.com S310N M3IA321 NVId #JIIN?!3d $:33d ❑ ❑ 111Vr3d 3H1 SV S3A8 S NOI1VOIlddV SIR!. ON S9) S310N N01103dSNI IVNI3 ,LINO 3Sf1 N0103dSNI?J0d 3DVd SIHI S310N NO1103dSNI SVO HOflO --� I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1.; CITY lA c Si i` nm I7I\ l(4 MA DATE 3 .3/ .1-1- PERMIT# 1-z- ti 1...k l JOBSITE ADDRESS 6-9Inle LS7t r RD OWNER'S NAME Y()1l'[ tA41t5 G GVVNER ADDRESS TEL TYPE OR FAX PRINTOCCUPANCY TYPE COMME DIAL❑ EDUCATIONAL CLE ❑ RESIDENTIAL �RLY NEW:❑ RENOVATION; REPLACEMEIJT: ❑ PLANS SUBMITTED; YES❑ NO 0 APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 q 9 to 11 12 is BOILER �, BOOSTER CONVERSION BURNER COOK STOVE / , DIRECT VENT HEATER DRYER � - �-j— FIREPLACE • --�- FP,YOLATOR FURNACE - / - R E C F E.- . -`-- GENERATOR �_. _ -_--- �--- GRILLE �— INFRARED HEATER 1 LABORATORY COCKS MAKEUP AIR UNIT BUILDING ��d HKrdT ,f Li OVEN ► gy. r POOL HEATER ROOM!SPACE HEATER ROOF TOP UNIT TEST ---- UNIT HEATER INVENTED ROOM HEATER �— WATER HEATER / _ _ OTHER [ { 1 1---- INSURANCE COVERAGE I have a current liaf,ili 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 COVE .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. SIGNATURE• OF OWNER OP,AGENT CHECK ONE ONLY: OWNER ❑ AGENT 0 rI; 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 compf n e with all Perti t provision of the""' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � 47 Li j PLUMB R-GASFITTER NAME go)) v/llsc N LICENSE# (537)9 SIGNATURE MP ! MGF❑ JP ❑ JG-- ❑ LPG'❑ CORPORATION❑# PARTNERSHIP El# LLC 0# 1� COMPANY NAME U)rs PlynOl/1 at n ADDRESS S /Slc- G i 55 R(t4r RD CITY AAIS STATE ZIP TEL TEL FAX CELL nil 3S3 Fit)I EMAIL will 1Gc/, S-6 ( CI ax f, Co rn ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT n FEE: $ PERMIT {t PLAN REVIEW NOTES