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HomeMy WebLinkAboutBLDP&G-21-000167 !► MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • r CITY YARMOUTH MA DATE July 13,2020 PERMIT# BLDP-21-000167 JOBSITE ADDRESS 481 BUCK ISLAND RD UNIT 9CD OWNER'S NAME CASEY PETER JOHN G OWNER ADDRESS 432 ADAMS ST MILTON MA 02186 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO El 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❑ 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Michael R Mcbride ADDRESS. 1 Mayflower Ln, CITY South Yarmouth STATE MA ZIP 026644220 TEL FAX CELL EMAIL Y irr 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 f . MASSACHUSETTS UNIFORM APPLICATION FOR A PERM T TO PERFORM GAS FITTING WORK CITY w G7. MA DATE PERMIT#,( L D�s 02� f� (o✓ JOBSITE ADDRESS 9 6 / ''- Ili(�L,�(,OWNER'S NAME f4 4 6 T GOWNER ADDRESS 7 61)1TEL 3 L TFAX TYPE OR OCCUPANCY TYPE COMMERCIAL.1_ EDUCATIONAL J RESIDENTIAL, PRINT CLEARLY NEW:;_I RENOVATION:_( REPLACEMENT: - PLANS SUBMITTED: YES NOJ' APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _.__J I_______I_._.__I I__J I_ J__I—J__I__I 1_.._I—J BOOSTER =J. I I I t— —_I._j —1_._—I I—J—J_I CONVERSION BURNER I I I I I_J I _J_J I I _I COOK STOVE I_I __I L-1 __:_LI_-3 I DIRECT VENT HEATER I_J_I,_I__J I-J-1 . 1_j I �—1 DRYER- —J—J :_1_1_____1,._____I _1 .. .._ I_I _- I_ I'—J FIREPLACE __I—J I__I__--_J i I I i I.—J_J_! • FRYOLATOR __I—_J�,_ iJ._i-_I -... 1 I I , —I __J J i FURNACE __—I—J ._ I_J I I I ___1 _______I-- --I----I I I GENERATOR ;_ .. . I I I I I 1 i-1 !__; I I—_ GRILLE __-,i I_J 1____I I_J_J'____I- I.J._.._J ___J _._J INFRARED HEATER _ I__I I _I I__ __I__I I_J _I—J 1_J ! _ .__J__i I___JJ_J_.._.__I______I -_! I J LABORATORY COCKS ( �__J�I. �,. � ICI it MAKEUP AIR UNIT I. .1 _I .1 — f 1 V 1. V • I • I 1�J OVEN 11 .. __ I ► I I I I _�� • ____J__�( I POOL HEATER �I—J_..__.J__.._I . . .I I..a_:���_I J_.____I aJ.____J�_J I ROOM/SPACE HEATER _____1,____, 1 I.___�i 1 1_ _.-._Id r I _I _1 ! 1 I ROOF TOP UNIT __,�! 1 1 .__ 2 1 I�J I_�I—J TEST _a_.-..I____I '_ _'_._ I 1 tc'' e . 1--- >--I I UNIT HEATER ! 1 ! _�_I__ 'a_;...._1.____J -- I _._._._. - I____ I___._I_ _I UNVENTED ROOM HEATER _,J ___..,J I _.'___._.' '_____i I J______I__I_____J _.____I_-,__1 WATER HEATER / I .J�1 I._._.._.I__ _I_____ _ .I _. I._:._-J I ••_____J_____J ti OTHER I __I: . ._I_,I_._J I_�I l . _.I_._._.J I_ ._I ._I�r1 __J I 1_1_.____J_._T _.__J__._._I ._I______J_.__J._._J'___I__-1_-J I____I__I__ I _J 1 I I____J I,____-I I I I i t !_ i i_ I !-._...__i __JI I _ ! I t __— INSURANCE COVERAGE _ tI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1:416-. J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY J BOND I_I 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 '_I AGENT .._J 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 C pter 142 of the General Laws. (J PLUMBER-GASFITTER NAME M,L �et,- A-J r I I LICENSE# 1��fI Ix. SIGNATURE MP_I MGF;_..J JP 6 JGF J LPG! J CORPORATION J# 1 1.PARTNERSHIP J# Or'/ t LLC J#` I COMPANY NAM �j (A, - p4-44--I.ADDRESS ' i2 0 5�G 1 rive_._ I CITY (/J17qff7O[//`�1 I STATE ZIP �^ ITEL 77 __r __ _� FAX I CELL'. . EMAIL: 1 �Vi-> ,' h1 L8 *!`; t�,cvt-1-1 L • C Q '. 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 • %AA t ' it-A3a t1C.'C` •