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HomeMy WebLinkAboutBLDG-23-002718 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY YARMOUTH MA DATE November 16,202; PERMIT# BLDG-23-002718 tl JOBSITE ADDRESS 29 DOHERTY LN OWNER'S NAME Adam Aiken G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 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 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 0 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 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherinecoastalphc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ El FEE: $ PERMIT# PLAN REVIEW NOTES � A N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kAa CITY: Yarmouth MA. DATE 1 1/15/2022 PERMIT# tJ r JOBSITE ADDRESS: 29 Doherty Lane OWNER'S NAME: Adam Aiken OWNER ADDRESS: 29 Doherty Lane W.Yarmouth MA 02673 • TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL[] EDUCATIONAL El RESIDENTIAL ci PRINT CLEARLY NEW; RENOVATION:❑ REPLACEMENT:I: PLANS SUBMITTED: YES❑ NO APPLIANCES7. FLOOR-4 Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 '1/4.J BOILER BOOSTER _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 1 DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE Er} INFRARED HEATER W LABORATORY COCK • MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER .I ROOF TOP UNIT fi TEST UNIT HEATER t.0 UNVENTED ROOM HEATER WATER HEATER Gas Main/Service Installation 1 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND 0 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 J Gilbert LICENSE# 13573 1G TURE COMPANY NAME: Coastal Mechanical ADDRESS: 21 L Fruean Ave CITY S.Yarmouth STATE: MA ZIP: 02664 FAX: TEL: 508-737-8747 CELL: _ _EMAIL: Katherine@Coastalphc.com MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLCV# 4350 E h9 AC C SSVCL-IiAQ,rtr.tQ- _COCAStr tphe.Go kv,