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Home My WebLink AboutBLDG-22-002897 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�-- CITY YARMOUTH MA DATE November 18,202'PERMIT# BLDG-22-002897 1 JOBSITE ADDRESS 150 WARBLER LN I OWNERS NAME 'WOOD JANICE G OWNER ADDRESS 601 N SPAULDING AVE APT 13 LOS ANGELES CA 90036-1823 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES❑ NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND ❑ OWNERS 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❑JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑#I COMPANY NAME: 'MICHAEL R MCBRIDE I ADDRESS. 19 Rustic Drive, CITY 'West Yarmouth (STATE MA ZIP 02673 TEL FAX 1 1 CELL EMAIL Istinger.mcbride(o.gmail.com S310N M9IARI NYld #IIIN2:3d $ :333 El El 1IV Rd 3Hl SV S3A213S NOilV011ddd SIH1 oN saA S310N N011D3dSNI 1t'NI3 A1NO 3Sf12i0133dSNl 2i0d 30Vd SIH1 S310N N01103dSNI SV0 HJfO 1 1�_4_I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rl CITY (j f Cj r"n^Q�J ` "r MA DATE• 1i Z -(PERMIT# Z Z - 7$�i JOBSITE ADDRESS' ({/Q r b r y2c L OWNER'S NAME Trvn i a W 06 L. f G OWNER ADDRESS .. ----- _ .4 -_ _ _ 5D-53-1 TELL] FAX' J: TYPE OR OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL PST J RESIDENTIAL CLEARLY NEW:,I RENOVATION:-I REPLACEMENT:%I PLANS SUBMITTED: YES D NO APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER /. i____ ..._I____!_____I______I• I ____I,__1 —1 J_____I,—J BOOSTER I I r I f•-J_1-I-1,—1.—� I'—f-1____1 CONVERSION BURNER I__( f j_J I f.�.__J_J i i__1,_J______1 COOK STOVE • I I..-____I —f_-J —J•-� -J—i-J - IJ DIRECT VENT HEATER ; J_J_1 f I _�"=J_i I_:1 _�-:_ __1 DRYER . I I I-J` l - I--J -I I ._- I_I I-J FIREPLACE ._ -I . J _ 1 t-_J—I__J _I ._ i-_-____I, 1 -i—J_�_ ____1 FRYOLATOR - ---I -.-I__.. _ j FURNACE I J-.—I. I—�.. • l I _IJ-_1 I_-____I----1�,1 I GENERATOR i I I I I 1. ----J—__J I- 1 GRILLE J f J..�__.! I . _ I. 1. I;- - i_.0 �J.__J _J J INFRARED HEATER . - -I - -- I,_J_ 1 II.-__J_J --- ;,-J __J_I_I_-J LABORATORY COCKS I 1 J ; i_J I___Lj__J __-__J_J-_J I_J_J MAKEUP AIR UNIT _J_1--I I:_-J OVEN -- I I I I I _-J. I 1 I I _J—J—_ J_ _ i i POOL HEATER •• I s�1 1 I I___I �___J__I J _____J_____I______I_I - ROOM/SPACE HEATER __ 1 I_ I i I I 1J - I_ { I i I 1 f ROOF TOP UNIT _."•I r I ! _ i I i I 1 i i I i TEST ,I i i i J 1.-_.1 J I i i f I UNIT HEATER , I i _� _Y1 _ i _J 1 �J _ — UNVENTED ROOM HEATER J J + s i _J :_J_ i,J I_ 1 __- _J _____ I WATER HEATER - I • • I'• I I I ._ - - �J—J t - J . OTHER I I i . _J I r I . I I- I _•-_--J_ I 1 -_j 1 J I I-J I - I _I-__-I I ' -1 - I'-J __J._____I t I�LI-_1_ I_J__--� +_ J I I I- I__(-I I__LI i I I i • l I -J I 1 . I 1 +.. INSURANCE COVERAGE 46 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ig NO . J Ilb 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 Li 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 U 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 b in complianc with all Pen ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (k. PLUMBER-GASFITTER NAME`I1V11 4PL c rr LICENSE#R0-7 i SIGNATURE MP —1 MGF ,J JP . -.._.. __ __ JGF� LPGI _J_ CORPORATION J# P 4 p PARTNERSHIP_i# COMPANY NAME`I C &Q 1" ' - i ADDRESS 37 rG A f i f/t-- -• --- CITY Han n 1 S STATE.I ZIP j� �TEL �� I ��6 7� ZZ- I FAX - --- -- ---._____ ._ I CELL: • - IEMAIL. S Alf,- .t c rt��, _ . __ . - - _ _i ✓`‘^4-1 n AAI Email • . ROUGII 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 •