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HomeMy WebLinkAboutBLDG-22-0024274 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE October 27,2021 PERMIT# BLDG-22-002424 JOBSITE ADDRESS 118 CONWAY DR I OWNER'S NAME MCCARTHY CHARLES J 1 G OWNER ADDRESS MCCARTHY MARY WYSE 43 GARDEN ST MILTON MA 02186 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL❑ PRINT CLEARLY NEW: m RENOVATION:❑ 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 _ _ GENERATOR 1 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 Stephen Winslow LICENSE S 12298 SIGNATURE MP❑MGF❑JP❑ JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. B REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectiooslUtefwinslow.com S31ON M31Aa1 Ndld #JIWH3d $ :33d ❑ ❑ 1.1M3c1 3H1 SV S3A213S NOLLV011ddd SIHl oN SOA S310N NO1103dSNI IVNId )C1NO 3Sf1 H0103dSNI 21Od 3UVd SI1-11 S310N NO1103dSN1 SV9 Honcmi MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ': �'' ': `� CITY YARMOUTH MA DATE 10/18/21 PERMIT # <. JOBSITE ADDRESS 18 CONWAY DRIVE OWNER'S NAME MARY & CHARLES MCCARTHY ,...); G OWNER ADDRESS SAME� i TEL 6173068238 FAX ..5 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL j RESIDENTIAL (n PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ' NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1.1 BOILER _ - BOOSTER r . CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 1 DRYER 4 rb FIREPLACE \,‘.) FRYOLATOR FURNACE _.. GENERATOR 1 GRILLE INFRARED HEATER „ . 1 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST —, UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER 1 _ OTHER GAS PIPING INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ' i I NO a1-1 w I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE INDEMNITY BOND [ µ 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 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 b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc i a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME STEPHEN WINSLOW ` LICENSE # 12298 1 SIGNATURE _ , MP i MGF . JP JGF r LPG' CORPORATION i ''# 3281C i PARTNERSHIP' # LLC # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 18 REARDON CIRCLE CITY SOUTH YARMOUTH STATE ' MA ZIP 02664 ITEL 508-394-7778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW COM