The URL can be used to link to this page

Home My WebLink AboutBLDG-22-3565 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e CITY YARMOUTH MA DATE December 28,2021 PERMIT# BLDG-22-003565 kt,11 JOBSITE ADDRESS 27 PLYMOUTH RD OWNER'S NAME HAMILTON LEE M G OWNER ADDRESS 27 PLYMOUTH RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL al PRINT CLEARLY NEW: ❑ 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 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 ❑ 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 0 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 Richard Olsen LICENSE# 10335 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: RICHARD P OLSEN ADDRESS. PO BOX 2026, CITY DENNIS STATE MA ZIP 026385026 TEL FAX CELL EMAIL officeto7.olsenplumbinq.com 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 1S--,— R �1`e�F r r" • U 4 go 0 f fi __. ,.. ..__ .1 MA DATE LI.2. Hi.�2 O� �....I PERMIT# 21 - g C to{ . __ ) , LOU__W.�.. .... OWNER'S NAME U C,5, , , ► t L r_..__.� .w.___ DE 6 21 106 ITE DDRESS ll. CYI Tom? U OWN R .DDRESS L _ _. 7-1 TEt;�O SL J) s3ClC1 h FAX Y . BU arti fscbtA TMENT CY TYPE COMMERCIAL ED UCATIONAL DUCATIONAL RESIDENTIAL CLEARLY NEW:[ RENOVATION:LJ REPLACEMENT: PLANS SUBMITTED: YEST. ; NO , APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ; r 1 • ' .� ,. BOOSTER 1 Iv1. " 1 ---1' 1l, II ,. CONVERSION BURNER :� f ' _ T COOK STOVE ,.. 1 DIRECT VENT HEATER 1 - , DRYER , n.. ---i.... t ` m ,1 -, -: N.. FIREPLACE a' FRYOLATOR ,1 1_- , ;s :-11I I I , ' "' 9 _ FURNACE Pis I� , GENERATOR l ��i r I GRILLE 1 .. . j r— INFRARED HEATER I $ ! . _ I LABORATORY COCKS 1 1 1 _ MAKEUP AIR UNIT ;.W i _- , _It - _ E - , V i :I -1 (`. OVEN i I f .__, 71 - __ g 1 POOL HEATER , ..,.L _` . -} __°---, __�.. i _ 1 .1 ._ -. ROOM I SPACE HEATER i a s ��'' _tl ROOF TOP UNIT I 1 r.. _. I TEST 1 j. ..� .,._.., a� UNIT HEATER - I, 1 , __.W wa,. � ...w I UNVENTED ROOM HEATER `_ Ir ' i i a ryj_ I .,,, �3 " ''. m . WATER HEATERt 1 1 d OTHER 1 _�_.. _ _� IIM _ �MI INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ' NO {.._.7 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I!] OTHER TYPE INDEMNITY n 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 Li 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 tot best y owledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance-wi all P .in ' i of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ---- I M10335 I 1 LICENSE# SIGNATURE PLUMBER-GASFITTER NAME Richard Olsen � _ MP`!( MGF P I JP" -, 6 . 1 PARTNERSHIP�,_,b# LLC y W;#I JGF LPGI, CORPORATION # 216 COMPANY NAME: Olsen Plumbing&Heating —!ADDRESS I P.O.Box 2026,357 Hokum Rock Road CITY LLDennis 1 STATE MA ZIP 102638 TEL 1_508-385-5290 _ _* J EMAIL rl.0 C. CQ1 5 _,_ FAX 508-385-6963 �CELL I- N�. U IQb.J NCB .CO fY1, _,.®,..., _s.._.