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Home My WebLink AboutBLDG-21-005112 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �_ CITY YARMOUTH MA DATE March 10,2021 PERMIT# BLDG-21-005112 L i= JOBSITE ADDRESS 108 BERRY AVE OWNER'S NAME mary miller G OWNER ADDRESS 108 BERRY AVE WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 12 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 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 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 El MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa(acoastalphc.com 41. ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El El FEE:$ PERMIT# PLAN REVIEW NOTES ` _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK v --..atijiiff.,34 CITY WesteYarmouth MA DATE 03/09/2021 PERMIT# 1-D 6-1(—Ob S/1-L JOBSITE ADDRESS 108 Berry Ave i OWNER'S NAME Miller Residence 1 GOWNER ADDRESS 23 Otis Lane-Bay Shore,NY 10706 TEL FAX 1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL LI PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:I ' PLANS SUBMITTED: YES D NOD APPLIANCES- FLOORS-4 LBSM , 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER i _ CONVERSION BURNER �, ! .� COOK STOVE ! i� I DIRECT VENT HEATER �' 1 " I Ri DRYER _ _. _ �. o -. FIREPLACE m ait,airing man 1 iil iiiiH FRYOLATOR FURNACE i GENERATOR GRILLE GRILLE I I i �I f WW INFRARED HEATER ;I i LABORATORY COCKS 111111111111111111111111111111111111111111111111111 NM MilJAPB 1.11111111111111111111 MAKEUP AIR UNIT IIIIFIIOFIIIIIFIIIIIFIIIIIIIIIIFIIIIIIIIIIIIFIIIIIFIIIIIIFIIIIIIFIIIIIIIIIIIIIIIIIFIIIIIIIFI OVEN il POOL HEATER Fil,' in ROOF TOP UNIT isme, __ TEST UNIT HEATER �i I UNVENTED ROOM HEATER �111111 . _ WATER HEATER 111111 OTHER 1 1 ,__ I, Il 1 Il INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LI NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY U I OTHER TYPE INDEMNITY Li BOND LI 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 Lj AGENT Li 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. ?Tel _ PLUMBER-GASFITTER NAME Troy Gilbert LICENSE# 13573IGNATURE MP LI MGF Li JP LI JGF LPGI LI CORPORATION LJ# PARTNERSHIP Litt 1 LLC LI# 4350 COMPANY NAME: Coastal Mechanical ADDRESS 21 L Fruean Ave CITY South Yarmouth I STATE MA ZIP 02664 ITEL 508-737-8747 FAX CELL 508 850 6955EMAIL lira acoastalphc.com