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Home My WebLink AboutBLDG-23-002456 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ul;'' CITY YARMOUTH MA DATE November 03,202; PERMIT# BLDG-23-002456 • JOBSITE ADDRESS 213 SOUTH SHORE DR OWNER'S NAME IMPFE MICHAEL R G OWNER ADDRESS KAMPFE KAREN QUINN 18 SHORE SIDE DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 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❑ 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 William Heath LICENSE# 12021 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: WILLIAM 0 HEATH ADDRESS. 265 GREAT WESTERN RD,45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat3304gmail.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 • IEDEIVED NOV 03 2022 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTMG WORK BUIL'JON 7-7 TN ENT By: v/� PERIM 2 a • `� ✓t v►c�7'1. MA. DATE: No J Z L�t 2- 3 -Z y sS- JossrrE ADDRESS: I S .Sh o a_d -Si o D2i✓ts OWNER'S NAME k m e G OWNERADORESS: 2-t 3 S S H o2� d?i v� TEL: b 17. 93S-(,Z 1O FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL la" PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:(Er PLANS SUBMrrTED: YES❑ NO❑ 'APPLIANCES'1 FLOOR-* Bsmt 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 ' GRILLE INFRAREDFEATER ill LABORATORY COCK _ kMAKEUP AIR UNIT _ . . OVEN POOL NEATER ROOM/SPACE HEATER _ _ J ROOFTOP UNIT fi TEST z UNIT HEATER r V UNVENTED ROOM HEATER WATER HEATER _ INSURANCE COVERAGE I have a curmnt liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ENO ❑ If you have checked ,please indicate the type of coverage by decking the appropriate box below. LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I am awe 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 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)reganfam this appication are true and accurate to the best of my Knoe+ledge a ndttart all plumbing wait and Installations performed under the permit Issued for tills application will be In compliance with all Pertinent provision of the Massachusetts Staff Plumbing Code and Chapter 142�ofthe General Laws. PLUMBEWGASFITTER NAME: W'cc(A rn /4A-%/I l LICENSE# /Z'i( IGNATURE COMPANY NAME: i4 S e w i LC_ Co •Y,�n .i; ADDRESS: 'lir '27 4inr f 2E'"r:( 7 CITY Sit'-') STATE: 1","-- ZIP: 07 T-4 3 FAX: - »L •/o o c CELL: 'f Yt7• S/7 v EMAIL MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# C hirs1/G ADD2e•SS: g;l l t )2 o 4 i 3 3 0@ y in.:/.