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HomeMy WebLinkAboutBLDG-22-004669 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK g 3 CITY YARMOUTH MA DATE February 23,2022 PERMIT# BLDG-22-004669 JOBSITE ADDRESS 15 GARDINER LN OWNER'S NAME MCKINNEY MICHAEL P G OWNER ADDRESS MCKINNEY DONNA 5 DEARBORN RIDGE RD ATKINSON NH 03811 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ 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 1 _ DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 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 1 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 Charles Cashin LICENSE# 10677 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG! 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: CHARLES A CASHIN ADDRESS. 14 ROBERTS RD, CITY BOXFORD STATE MA ZIP 019211822 TEL FAX CELL EMAIL none 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 20. Da ' F ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ri-Ar .. l-t . `� c ti�2` MA DATE Z' - 2S ZZ, PERMIT# 1-1-" (-I(il&S i � ._ 3 23��12 ( JOBSITE ADD ESSL i`2 6 -LE — OWNERS NAME-2; h ill . ,- - B D NG u PARTMENT By .___4_OIANER�'DDF ESS I4'I-4detife (+tie SES?C TEL/1 — — 1.52-6 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL t. PRINT CLEARLY NEW:❑ RtiENOVATION: 2J.. REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS--I BEM 1 2 3 1 5 6 7 6 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER TCOOK STOVE t DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE ti GENERATOR GRILLE INFRARED HEATER _ y , LABORATORY COCKS . MAKEUP AIR UNIT - OVEN POOL HEATER • ROOM!SPACE HEATER _ ROOF TOP UNIT TEST ..--- — -• --- UNIT HEATER I . �_ UNVENTED ROOM HEATER WATER HEATER __1 —� OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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. CHECK ONE ONLY: OWNER 0 AGENT ❑ ;• SIGNATURE OF OWNER OR AGENT -1-• 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 corn ' 'th all t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. L1i PLUMBER-GASFITTER NAME CHA-Q1e S CAS 4tIN LICENSE O67 Z SIGNATURE MP [GF❑ JP❑ JGF❑ LPGI❑ CORPORATION 0# PARTNERSHIP❑# LLC 0# COMPANY NAME SASH �`(. PI1\7C �q ADDRESS /4 RcfT( fe.) . CITY �� U f3©AL STATE RA. ZIP©1 ci.z TEL C (y 7•rD 7'2.i3 - FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES '(es No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT( PLAN REVIEW NOTES