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HomeMy WebLinkAboutBLDG-23-003407 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 20,202', PERMIT# BLDG-23-003407 ti JOBSITE ADDRESS 2 GASLIGHT DR OWNER'S NAME KENNEDY KEVIN J G OWNER ADDRESS KENNEDY J M T E&M P 52 FAVORITE LN EAST LONGMEADOW MA 01028 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ 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 1 FRYOLATOR • FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 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 0 OTHER OF INDEMNITY 0 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherine(aicoastalphc.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 I •yam MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 31 CITY Yarmouth I MA DATE 12/15/2022 I PERMIT# JOBSITE ADDRESS 2 Gaslight Drive _ _ _ OWNER'S NAME Thomas Kennedy GOWNER ADDRESS 2 Gaslight Drive Yarmouth Port MA 02675 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL RESIDENTIAL Ld PRINT CLEARLY NEW: i RENOVATION:J REPLACEMENT:0 PLANS SUBMITTED: YES LI NO APPLIANCES 7 FLOORS-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i BOOSTER CONVERSION BURNER , COOK STOVE i 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE ' GENERATOR a GRILLE , INFRARED HEATER : LABORATORY COCKS MAKEUP AIR UNIT I I I _ 1 OVEN 1 : I � -I �� POOL HEATER ,I ROOM/SPACE HEATER 1 1 1 - ROOF TOP UNIT TEST ( III UNIT HEATER I �.' UNVENTED ROOM HEATER11 WATER HEATER II 1115'51111 =nu 1 OTHER Gas Line To Fireplace Ins. Iii 1 _ w , 1 : , , _ _ j INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO _ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LA OTHER TYPE INDEMNITY Li BOND Li 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 CHECK ONE ONLY: OWNER ,„ 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. n`� /44 ei PLUMBER-GASFITTER NAME Troy Gilbert LICENSE# 13573 1 SI ATURE MP Li MGF I JP II JGF Li LPG'Li CORPORATION 0# PARTNERSHIP LP I LLC # 4350 COMPANY NAME:ECoastal Mechanical ADDRESS 21L Fruean Ave CITY S.Yarmouth STATE MA I ZIP 02664 .TEL 508-737-8747 FAX ]CELL EMAIL Katherinea@coastalphc.com