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HomeMy WebLinkAboutBLDG-21-005989 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,�",1 c` CITY YARMOUTH MA DATE Apnl 15,2021 PERMIT# BLDG-21-005989 II JOBSITE ADDRESS 35 GARDINER LN OWNER'S NAME judith badiali G OWNER ADDRESS 68 CENTRAL AVE MEDFORD MA 02155 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 BOOSTER CONVERSION BURNER COOK STOVE 1 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 ❑ 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsaefwinslow.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 -, , R MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -ai CITY !YARMOUTH MA DATE!04/12/2021 1 PERMIT# 6- 21- vo 516 JOBSITE ADDRESS 35 GARDINER LANE i OWNER'S NAME [BADIALI MATTHEW GOWNER ADDRESS I TEL1857.2031998 ;FAX r TYPE OCCUPANCY TYPE COMMERCIAL; i EDUCATIONAL RESIDENTIAL;,j CLEARLY NEW. : RENOVATION: 5 REPLACEMENT:�,� � 1,, PLANS SUBMITTED: YES,,�J NO; u' APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i E �. ,l BOOSTER iiiiiimiliiitmiliansiiiiiimillialinilinilliiNilliiini CONVERSION BURNER ( -I ii '— ` T —11, -11 ' COOK STOVE DIRECT VENT HEATER I t : DRYER 1 _ I.11!--:—ILT,17—.7171, i r, ..- FIREPLACE , _ FRYOLATOR FURNACET 1 GENERATOR a, i __,. _:_.f .._...�_ _ _ - ���f _.. GRILLE rt -1 - INFRARED HEATER i r i i '. ' z LABORATORY COCKS m�� z . t MAKEUP AIR UNIT OVEN g-_ . POOL HEATER i ROOM/SPACE HEATER �_ W __..__--, t � t ; ROOF TOP UNIT 4k TEST i l.x,w, ,: UNIT HEATER ' 1 UNVENTED ROOM HEATER . ` a iN WATER HEATER OTHER d _. il < W/O 548673$50.00 V _ a a�LL ,�1 w .u..{ ' e._.;F INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES : „ _.F. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ; , OTHER TYPE INDEMNITY BOND I__' 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 1. j AGENT ,r. 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 accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliaanc ajYPpdine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 71 • / y -. ^-^ PLUMBER-GASFITTER NAME STEPHEN WINSLOW1 LICENSE# 12298 SIGNATURE MP. 4 MGF V. t JP tLL- 1 JGF; i LPGI i [�Y CORPORATION # 3281 C ?PARTNERSHIP "#° LLC 1#1 COMPANY NAME:; E.F.WINSLOW PLUMBING&HEATING •ADDRESS i 8 REARDON CIRCLE CITY i SOUTH YARMOUTH i = i STATE MA ZIP;02664 `TEL i508-394 7778 FAX I 508 394-8256 CELL mN/A !EMAIL[INSPECTIONS@EFWINSLOW COM