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HomeMy WebLinkAboutBLDG-23-005532 * MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -64 CITY YARMOUTH MA DATE April 05,2023 PERMIT# BLDG-23-005532 II -j JOBSITE ADDRESS /,SO‘.SaT OWNER'S NAME GILMORE JOSEPH G OWNER ADDRESS 4 DORESETT DR EAST WALPOLE 02032-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO EEI FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 . BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER 1 • FIREPLACE 1 1 FRYOLATOR FURNACE GENERATOR 1 GRILLE 1 INFRARED HEATER _ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 ROOM I SPACE HEATER _ ROOF TOP UNIT TEST 1 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 Timothy Sullivan LICENSE# 12846 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: TIMOTHY E SULLIVAN ADDRESS. 1102 HANOVER ST,T SULLIVAN MECH INC CITY HANOVER STATE MA ZIP 023392043 TEL FAX CELL EMAIL ien.medairosta7.outlook.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 �-- / 30 '— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FIlTNG WORK � '. ,( // Z-a s53Z1 _��+ CITY: �Uu� lF}R171D� DATE y' ��,` -Aa 3 ER� -. JOBSITE ADDRESS: Sd S 2r3 . -OWNER'S NAME -- ep r 0,-,I,-)i o e Lf;G�� C G OWNERADDRESSy • esc_' $,_S po1f: filgoe 1017-7l9-61)DP FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL Z. PRDIT CLEARLY NEW:It. RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES '] NO 0 i a APPLIANCE81 FLOOR-. Bi , 1 2 3 4 5 , 6 7 8 9 10 . 11 12 ,_ 13 14 d BOILER 3os,000;,ru _ BOOSTER L. CONVERSION BURNER COOK STOVE 5a,000 B4U- I -° DIRECT VENT HEATER DRYER 20,non Va. I FIREPLACE I I Coy FRYOLATOR 1-7 FURNACE , GENERATOR tls,om bitt, i GRILLE L{o,000 j,Ik _ 4 V , INFRARED HEATER 441 LABORATORY COCK _ MAKEUP AIR UNIT OVEN _ „� POOL.•HEATER *I000 Of 1 ROOM I SPACE HEATER • _ 4 ROOF TOP UNIT TEST I _ _ , Z UNIT HEATER • IQ UNVENTED ROOM HEATER _ WATER HEATER [ - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES til NO ❑ If you have checked ME,please Indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY RI OTHER TYPE INDEMNITY ❑ BOND 0 OWNERS INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massechusetts General Laws,and that my signature on this perm It application waives,this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and informalion I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and thatall plumbing work and installations perkormed under the permit issued for this appl will = 'Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. �' PLUMBER/GASFITTER NAME: 1\\NAME: \ LICENSE# t !44 SIGNATURE COMPANY NAME`► ,►1ltvA-ti 1%doonm Clti, .1nc ADDRESS: I I Oak nrr of- WI‘v 4- CITY: }4-A'rZure2 STATE: Cfl1U ZIP• O S53 9 FAX-1$1- 1 - 5 99 TE.:-/Ri-)r11-9 9') CELL: EMAIL'jen_rner)a,ro'sea OA bril.Corn MASTENj,J JOURNEYMAN 0 LP INSTALLER❑ CORPORATION _4 PARTNERSHIP❑# LLC❑# E 1,7iv[. 091)TheeSS: yen, oledairol c oui-looK,( .. , . , ..:-.:... .. ; .„..,., ,:: . ' ,:',-,,_'_. .1;..., ;.--4,„"--;.:e,',..-=',,-----,•..,',' ,:, ...,...,__ .,,a..-.,,,,,,,;:',....;,,7,--..-:,'.; -:1. '''''',. .--;;;-- ,,,-':,:.,` - . 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