Loading...
HomeMy WebLinkAboutBLDG-23-002225 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .1 '4` CITY YARMOUTH MA DATE October 25,2022 PERMIT# BLDG-23-002225 JOBSITE ADDRESS 91 CHIPPING GREEN CIR OWNERS NAME Sue Quimby G OWNER ADDRESS 91 CHIPPING GREEN CIR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III 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 • DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT • OVEN POOL HEATER • ROOM I 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 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherineta7.coastalphc.com A- 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rim. Cln; Yarmouth MA. DATE:10/19/2022 PERMIT# —22ZS JOBSITEADDRESS:91 Chipping Green Circle OWNER'S NAME: Sue Quimby GOWNER ADDRESS: 91 Chipping Green Circle TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:V PLANS SUBMITTED: YES❑ NO APPLIANCES? FLOOR-, Bsmt 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 i, LABORATORY COCK MAKEUP AIR UNIT _ cJ OVEN POOL HEATER ROOM I SPACE HEATER �} ROOF TOP UNIT ,t TEST UNIT HEATER t.yl UNVENTED ROOM HEATER WATER HEATER 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 V 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 0 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 ell Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. /� ` � PLUMBERIGASFITTER NAME: Troy Gilbert LICENSE#13573 AG TURE COMPANY NAME: Coastal Mechanical ADDRESS: 21L Fruean Ave CITY: Yarmouth STATE: MA ziP:02673 FAX: TEL; 508-737-8747 CELL: 508-850-6955 EMAIL: KatherineRCoastalphc.com MASTER ' JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC '# 4350