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HomeMy WebLinkAboutBLDG-22-003322 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ==rr CITY YARMOUTH MA DATE December 10,2021 PERMIT# BLDG-22-003322 JOBSITE ADDRESS 4 COLLINGWOOD DR OWNERS NAME OHARA JAMES F G OWNER ADDRESS OHARA MARIBETH F 4 COLLINGWOOD DR YARMOUTH PORT MA 02675-1509 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 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 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❑ OTHER OF INDEMNITY El 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 as plumbing work and installations performed under the permit issued for this application will be In compliance with as Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME IR Peter Checkoway I LICENSE# 13417 SIGNATURE MP❑MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IR PETER CHECKOWAY I ADDRESS. 111 SCARGO HILL RD, CITY 'DENNIS I STATE MA ZIP 026382306 TEL FAX I I CELL EMAIL IcheckentAcomcast.net 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 4 ., _ f ___, CITY YARMOUTHPORT MA DATE L12/7/2021 PERMIT # y., JOBSITE ADDRESS[4 COLLINGWOOD DR, YPT _1611111 OWNER'S NAME SEAMUS O'HARA GOWNER ADDRESS [SAME TEL 774-836-0776 JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL ' PRINT CLEARLY NEW: i RENOVATION: REPLACEMENT: © PLANS SUBMITTED: YES NOID APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER L _ BOOSTER [ CONVERSION BURNER 1 COOK STOVE DIRECT VENT HEATER DRYER - i FIREPLACE FRYOLATOR FURNACE _ __ GENERATOR , GRILLE Ir- 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 I COMBI BOILERIWH 1 INSURANCE COVERAGE I have a current liability 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 COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 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 accurat t best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE # 13417 ATURE MP J MGF JP JGF LPGI CORPORATION I# [ PARTNERSHIP # LLC #, COMPANY NAME:. Checkoway Enterprises ADDRESS 11 Scargo Hill Rd _ CITY Dennis STATE MA ZIP 02638 TEL 508-385-1911 FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net