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HomeMy WebLinkAboutBLDG-22-006097 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R' CITY YARMOUTH MA DATE (April 22,2022 I PERMIT# BLDG-22-006097 Iit rf JOBSITE ADDRESS 61 WEBBERS PATH OWNER'S NAME MCDERMOTT WILLIAM F G OWNER ADDRESS MCDERMOTT LAURENA D 6 DALE ST BURLINGTON MA 01803 1 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND 0 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 Thomas Coughlan LICENSE# 8529 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION 0#I I PARTNERSHIP ❑#I ILLC❑# COMPANY NAME: THOMAS J COUGHLAN ADDRESS. 48 HERITAGE DR, 1 CITY WALPOLE STATE MA ZIP 020812240 TEL FAX r CELL EMAIL S310N M3IA32i NVld #.IlNi:l3d $:33j ❑ ❑ 111%13d 3H1 SY SRA213S NOLLVOIlda SIHU ON saA S310N N011O3dSNI 1VNIJ KINO 3Sfl 2101O3dSNI did 3OVd SIHI S310N N01103dSNI SVD HJl0d ...\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `: ag CITY 1 ' 't �1 A DAT _w.xx- _...., �--- � PERMIT # �2- — C a ` —? ` .: Ni.A;.:4f5'r.:' fsi#A,iY..;xi:'Ak. ::. `:.:N':.::,:Cw:,t.tsY:t�YitYHn�h'.,a'C<:G HF' 'C[. .. fiS:`:r.•.. "tiSK^< ..' ,x.K.vto,XCx.: fOt „ JOBSITE ADDRESS# !`; OWNER'S NAME I - �wxnm mm w�wmm . . . w�. m w r . wpm .�.a.... ....W, *we wmxx x.n G OWNER ADDRESS I FAX L,......... i TE TYPE OR OCCUPANCY TYPE COMMERCIAL.xM.. EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW. ..:. RENOVATION: I:a REPLACEMENT: PLANS SUBMITTED. YES NOkr APPLIANCES Z F II RSE C E i V -: 13 2 3 4 5 6 7 8 9 10 11 12 13 14 11 BOILER k ----w.._._. �. K..<. j' w rrx. £=.ow S R:.x..K«_M w a w`X.d.W, .. j� _ .. ._. ,, . ax„,.,.. ...,, k,„,,..sq>.,,, rin a a,,a,< t.,RY d „Yy' atwxa2 <pt^r,,. wa..> nDWfMw, {eh ,wn na , $, ,�.�..s�_ . ,._�w.q .. w�...a = I. Y . ......._ » , .BOOSTER d i s Sw } fi .,,, a,,,,,C-,i, *mi , xd ,v zr .k JYR+wua-Min.,�,..4, ..ud X1y Y fffe 3.11 ig ....1 ' 1,,,,W.VV, £:W. CONVERSION BURNE' I. i i ,x m , m y w •,wear= 4,.. <, > —. `.. —J ..--� ae.#F<..,—..e..„.ca :rw„..a,..,,„,.. , ,c+<.e- + , . ,,,„. „: ..„,:. :«...—.�r,.<,,„,;: "or�z,,,.aa £. .xav ww< .rfa� COOK STOVE __ a _ 1rmwf _ w , F _ « :1: ,. L,. : _, .. . DIRECT VENT NEATEN By: _ 1 .w, w.�....._..wmnM w..,�_,w..w...:` m.. ....m,nr m.wr« mxxw..« DRYER ' � 11 wm iXldX.<S-a'ir if,AF x..oK<',... siikik'osdtir:rLe:,t,,,K.00.Ki Ss,." , ,.�.,,,,Se9k:Kvk ?4<f4,m_x„'.,v..,, kk-;zCdk A,-?{W.12A, e. 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Hr s.r # <, us: k ,,,,,,, £.'„'t<.2 .\9a .......s: ._...,. kA r et .„ 2 '..xx.,. a..«...,,...,rv.:," ............... .,n.. k „.,a WATER HEATER - AA I` A x;cx„ra. .n.r., z:eow.: >R„�ax+»,:.-:roa :wr'aW,exrar ,x:.ro<,:axrx s:. s .rn6`�%a';;wsrnraraa i..,z:..:.v.\,w:,n.-e..'+hsiav<x::..atKr» t ;.a�. `ra:$•,�.ms:... .v aais,¢�x�Wrx',u b�xx,>sreaan�x xis .x,... ..m n....._.r..x ._...-,.,,.�._n_«.,,; ..............x ._ «., . .,......x« ...,. i. ....m..,.. 1 , r,, s , a: a = € OTHER • ...> : .= r3a. �.dg,,,,,V,V4: 1.4, �� t N \�d �� i� < . AaK � Id , «. r - a �s A.. ...,.. .. .x,. < s:. « § w € • x� m � , W : � w ; wW aI INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES %I NO L I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY �a 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 [ a AGENT 6�a:A? 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 comp ' ce with all Perti► - t prov ' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .......,,- PLUMBER-GASFITTER NAME g (//J► LICENSE # 5a .. SIGNAT ''E ,�d<tiaa. 3Y''0) C,KS�,.e`. aY@:a(tak,Ma ,lna4ccsXatCvt;:aa:.A'.�t Y.',adlkc:Y�kLSKD 3WCk- a,5.M->050 5055.b'iixa.s::.cCKs:. MP MGFi JP JGF LPG! ri CORPORATION � �axWa � i PARTNERSHIP Lj#1j D#L COMPANY NAME: j� ��•�- � � �I/C ADDRESS i � /n`id .. •svr:a 'a�sxa:,a�:•.a.a ,xx .s'*50c.a:,a,�,ro'.;a.<..., _ .. .,..:, ::. e5as.v;rb.-,,` .....,sz5050 .. e;£<wr.<avi ... .—, .- CITY a �.w w_ _ . . ....m w w xw� , Hwa..x is STATE ZIP I {//�) - 1—`1TEL . x� .f.A..*We.Me'.aa,tkxie'r,r:xw k.\ar.rdYk<�w-a«' xm,r<aea£ux 'e+ .a,.>tt„a'ef:?' �v.x•s:_.;...3>akaavta.W.amk.. mac,sx,`,,,,, zw.xo�s...' ,re: :ca„x,.�as,n'xu -:<w x.a'amaiWs.V . .....,...w.mv.... .... ...Y E nmr. +D 1 FAX ' CELL 1EMAILE ) to c ,..n �, w