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Home My WebLink AboutBLDG-21-005234 Jr _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =4'rkt: CITY YARMOUTH MA DATE March 15,2021 PERMIT# BLDG 21-005234 JOBSITE ADDRESS 31 CAPT CHASE RD OWNER'S NAME darlynne dix G OWNER ADDRESS 31 CAPT CHASE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ED PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 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 I 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 ID 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany@gmail.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 45 V c 11:) '�_- MASSA :HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYS, Si cei)o-c o u V MA DATES /0( PERMT#BL OG 1-1-0o C 2 S'I JOBSITE ADDF ESS 3/ C,9P r c/19Je ) .2 .-OWNERS NAME 9,9 ,? L y N nP x G OWNER ADDR SS i • i• TEL FAX _ TYPE OR OCCUPANCY'I 'PE COMMERCIAL EDUCATIONAL RESIDENTIAL y PRINT CLEARLY NEW: n NOVAT1ON: CEill� • PLANS SUBMITTED: YES NO l/ APPLIANCES 1 FLOORS-. BSM f 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _- r BOOSTER , CONVERSION BURNER _ _ - • COOK STOVE • DIRECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR d.._ :. .. FURNACE f , GENERATOR _ . -I . GRILLE _ • INFRARED HEATER _ lir 1 . - - LABORATORY COCKS - . , MAKEUP AIR UNIT OVEN _ . 1 _ . POOL HEATER _ _ ` ROOM/SPACE HEATER - . , _ - ROOF TOP UNIT _ . TEST . f - . -. UNIT HEATER I - . . - UNVENTED ROOM HEATER I - _ WATER HEATER - _ _ . . - - OTHER v I t ' f 1 -= INSURANCE COVERAGE I have a current liability insuranc policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 1/NO I iF YOU CHECKED YES,RIM IN ICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY 4SURANCE POLICY ✓ OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER !am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Lava,an that my signature on this permit application waives this requirement. CHECK ONE : OWNER AGENT SIGNATURE OF C TYNER OR AGENT I hereby certify that all of the details t id iron I have submitted or entered regarcrsto this sposeeeon are and or my kfl vtedge and that an plumbing work and Instal Mons performed under Me pima Issued for this application us be In pi •• of the Massachusetts State Plumbing Cods and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME AN CREW LEIGHTON LICENSE# 15130-M SIGNATURE MP v MGF JP JGF LPGI CORPORATION - 3734C PARTNERSHIP LLC # COMPANY NAME HALL OIL COME ,NY INC. ADDRESS 435 RT 134 CITY SOUTH DENNIS STATE MA ZIP 02880 TEL 508-398-3831 FAX 508-394-3068 CELL, EMAIL I�fyegmaftcom e"', . .