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HomeMy WebLinkAboutBLDG-21-004819 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 25,2021 PERMIT# BLDG-21-004819 .i.F„w RJ ino JOBSITE ADDRESS 12 SHERIDAN RD OWNERS NAME RIVE GAIL P G OWNER ADDRESS C/O GAIL BASSETT 19 CAPTAIN DORE ROAD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO ❑ 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/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 ❑ 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 Andrew Sullivan LICENSE# 25550 SIGNATURE MP❑ MGF 0 JP© JGF 0 LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: IANDREW M SULLIVAN ADDRESS. 47 FOREST DR, CITY MASHPEE STATE MA ZIP 026492332 TEL FAX CELL EMAIL no 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 = 1 CI1Y �_ __.._w..�__.___.- MA DATE JPERMFT # t-0 C1 `� ( - 1® � 1 JOBSITE ADDRESS: i '�- �" �-` DOWNER'S NAME S��� . _ Lis I �. � ._. i G ..y,.•m>+...NC"•S'iT1".P'Pl9'Y.TFTF 'PWi' ..Y'�Wtl'.OALs61P4'.,.�...5<.V.� —' i TIAf",'Yt..XfdMIiXNY1L„fyYCS': nezrw'-13ext 10."N4!sasc.......Ww�a..ri. OWNER ADDRESSµ TEL 'FAX •,•,•••"",��•+-..4.YfiFi'./c•.•-.•..-•--.; '.•-„Me11<iSEC•T.� •-•-•._.••.,y._•.•.�•e••�•••..YuelifN/ti- .X...•.....i+YAaVsiedd:Y.::,l'.V5'eiYLJ4'l/FY.+"«ti+. ' TYPE OR OCCUPANCY TYPE COMMERCIAL - EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: 7.7 REPLACEMENT: PLANS SUBMITTED: YES NOLj APPLIANCES 7. FLOORS-0 BSM 111 3 4 5 6 7 8 9 10 11 12 13 14 BOILER # n, . . ,a' ___ f__. Jr__ BOOSTER r.— g.1 ; ii CONVERSION BURNER '� ' aI _ Y i � aw COOK STOVE _ _ w. T _ �� _ _ _ ,. " DIRECT VENT HEATER - ,aF ( i f DRYER i I I %,_ #a{ ,r:. i er.,. f 'a id.�'...' o.m .r.-.w'<.w.. ,.,_.rnii rvc, t, s'..m�. ...... rt...�.•.m+ } f .,.r�u. � •:1 ..______r_ ,_____T.,....„.._,,,,___,„..____ FIREPLACE i c ,imitiomprmry FRYOLATOR ' ..� �. _ a ,.. . = «r� . �. ...w i ( FURNACE _._ ;� `i } �X I .x .x}!_ ££ GENERATOR 1 .Na. :.<.. .v.. .. ,1 1. , , :1 M w GRILLE INFRARED HEATER • f .. .5 LABORATORY COCKS jj { MAKEUP AIR UNIT W A - ''F. ,,__ _ ( 41 f i' • •. ## a+w.-'..-cn rc. wwTx�-.,r5w. ax S v.-�axa�< .I;a«xe.....:wx.- aa...rvawt<.+r c� - - x�,m -r9em-..ar- «a+a+•.-�c r...aw+,.�*.«wa.•a,• t..r.-y^.'.,• _as+saa.. ..,:'y.� r.:.... OVEN ;__ .___,_. � 1 � �..� �_.,i.__-. f__ � ;w.- � _...� �__ ....�..��._ _. 1 «zraau ` ,e+-' asc.eK. `.,.ws-^s:, , a--s-a-_,,,w.NS'`,,„ },r1e„, .. ?kaK,„,„„+aa .ifrarr.,:-.tr�.nare„,,,,,ra�e9,„,k,t+.�s>..„,.4=}s `++: ,,,,�na,°47-5�c IP,I.:0.4,:ts,. svxi,9,013 L0.40,00 .r••.•.:i r. POOL HEATER u-xa. �:• s L..z ..4. . >n '1 .,.�.�, .4 - -a-a„ .-,' rx:, v x Ikx 4 .. .x_._. .:�:�:��. - i-1...., .m : 1.�.x..v I,..,S«.R..,, ROOM 1 SPACE HEATER ^ ;. _ ��__ 3� 'r y_ ,� } «-__ _ ___ _ _ __ . _ .� _ _,_____, ROOF TOP UNIT # _ '[ �' ..m „ } �. 1. ii------, TEST �._�_ .� •r 'T ~ I k T _ _ UNIT HEATER :-- 1, n .� : ,! �� 1 i .,.- I 1' i t ....i• .._.,.__.: ....... .,.............fi r.. .. t, __ .s v .. UNVENTED ROOM HEATER 'i._�M ,'ir 1[ '1 it . _ #' 1 .� �41 , li _ I �, in . ,`+.fR ,,. ew .,a- 4 L - E.re.Z.'<••b ra.-,•+H.< B.lHf tfiY-TT.L+�' _ ^J: �MTM1i:M' .0' 5. mseaoso w w n.r.w.- .,«. 7._»_.._ ._.ram .w WATER HEATER __._ 5 ' . 1 } I OTHER } I __ __ � �_ . t i g3g3I . _ I a» , } -.e.:: mrz ,~ c+aA>r+•�.j ,rcaw w.:an '�a- tm:.:-c*c 4,wn r n�YwSr ..�e,+5ras= ^3 i-r.» s,.a=e'''''. +�txtei;z»''a*t 1 zai,--- x r 1 i iI • «r ! l j i E v � � I �I •� �_ I I � l �..... ._ 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES FT; NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ,,---- ._____. ----, LIABILITY INSURANCE POLICY Y OTHER TYPE INDEMNITY BOND H „. 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 J 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 best of my knowledge and that all plumbing Nork and ins;:allations performed under the permit issued for this application will be in mpliance with inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 2_�.. "�p .•C' PLUMBER-GASFITTER NAME .-1 °G'✓ rya • 1 LICENSE # 0 4 SIGNATURE MP MGF JP JGF LPG CORPORATION �# = PARTNERSHIP # LLC t# ^ F "OT'1(IV'-r. "••-lwr'l..rr`Oaew<.is: d aSiaY +.AQiYc:'.-n r� ........_n.....s _ '.«w,....rs.+,.....tx�a .tea. „.. COMPANY NAME! 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