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HomeMy WebLinkAboutBLDG-22-001125 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK / �' E� CITY YARMOUTH MA DATE August 30,2021 PERMIT# BLDG-22-001125 JOBSITE ADDRESS 42 DRIVING TEE CIR OWNER'S NAME Tom Carti G OWNER ADDRESS 42 DRIVING TEE CIRCLE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES ❑ NO 0 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 GENERATOR 1 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❑ 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 LESTER WADE LICENSE# 14569 SIGNATURE MP❑ MGF © JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: 'LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD, CITY COTUIT I STATE IMA ZIP 1026352702 I TEL I FAX 1 1 CELL 1 I EMAIL 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 CITY j Ni urn(f U TN MA DATE 8 [14 t 11 1 PERMIT# JOBSITE ADDRESS 41 prtv1n9 lltt Grt.OWItiER'SNAME TOM LOX GOWNER ADDRESS Sta.. c.Lbove. TEIly(1)59® • mill FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL [,) RESIDENTIAL PRINT NEW:Q RENOVATION:0 REPLACEMENT.❑ PLANS SUBMITTED: YES❑ NO[:}' APPLIANCES 1 FLOORS--. BSM 1 ' 2 3 4 J 5 6 1 8 9 10 11 12 13 14 BOILER t...____. .__...t_.. { BOOSTER 1 � 1---1 .' :fi j • CONVERSION BURNER 1 , r _ (=( I 'a A COOK STOVE - _ ._�� ��_W 4: f -�1 U i DIRECT VENT HEATER 1-7 '. . dr _�r E ii. DRYER —I_ :� . r II .I (--d_ ,+ i FIREPLACE -j ���_ ("--1 h _ FRYOLATOR 7 I _ , FURNACE � is y. GENERATOR C A •t 'r�rr��..._...sv..�_.�r�a� r.a . _ I GRILLE ( I--.' 1-1-1- IiI ii- , it 9 INFRARED HEATER - i j � 1,� - _ LABORATORY COCKS �i � {� 1 . j , MAKEUP AIR UNIT _ OVEN r—i----. _ • jam- — __ I POOL HEATER j_ 1 I '{ I ROOM!SPACE HEATER 1 T' L (-----1--' ROOF TOP UNIT h j I , ( I _ L�- TEST :1_• ii UNIT HEATER j � .. (—' 1. M .. n. .� r-', UNVENTED ROOM HEATER --,fir �§ .1 WATEP,HEATER i OTHER sta ;I � I= w�t ! j I� _ !i jLCl ,i. =__ ' INSURANCE COVERAGE _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.'i42 YES 540 ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE 807,BELOW LIABILITY INSURANCE POLICY Q/ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCEWAIVER:Tam aware thantti iii;ertsee-du-e-not eth-e-inaura^ce ege-t liredl -Cheptec1142a 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 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 ins;aUations performed under the permit issued for this application will be in co pliance with all Pc nentnent provision the Massachusetts State Plumbing Code and Chapter 142 of the General Laws ��rr✓ /i( J PLUMBER-GASFITfER NAME Le54cr Lt)elete. j LICENSE# 445bq VY SIGNATURE MP n MGF JP❑ JGF❑ LPGI❑ CORPORATION❑4 PARTNERSHIP LLC ❑n COMPANY NAME:(,eye tee/ i _,e.�,r{-RNAOPRESS Q3 gc^wets iY, PJ' CITY MA 5L4 p e r, STATE AAA ZIP d at;q J TEL•50 5Jff71- Ft' S_7 FAX 1 CELL,50$- .5Z1 - EMAIL 1'-PO Cr, GC-t'p 9 e*le :4•0 r 5 . C.c,:n 8"$S'$