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HomeMy WebLinkAboutBLDG-22-001890 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK el i CITY YARMOUTH MA DATE October 04,2021 PERMIT# BLDG-22-001890 JOBSITE ADDRESS 481 BUCK ISLAND RD UNIT 8AA OWNER'S NAME Beth von Staats G OWNER ADDRESS 481 BUCK ISLAND RD UNIT 8A WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 1 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 , 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 0 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX ( CELL EMAIL inspectionsAefwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �.ire — � j �.._ . _1=im. CITY YARMOUTHMA DATE 19129/21 1 PERMIT# 22-i 8SO JOBSITE ADDRESS!481 BUCK ISLAND ROAD UNIT#8-A OWNER'S NAME BETH VON STAATS G _ OWNER ADDRESS ;SAME TE 1 _._ 5087377413 FAXw �� TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL IA PRINT CLEARLY . 1 NEW: RENOVATION: p REPLACEMENT:1 PLANS SUBMITTED YESI_„ NOL=„ O APPLIANCES 7 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 VD BOILER _ _ ._.__ I BOOSTER ,._ ,'' i 1 , i . CONVERSION BURNER �J _ Ir S COOK STOVE �... ,. .. i .- r" DIRECT VENT HEATER " � i L ) DRYER I i I.._ I ,. t 1' FIREPLACE I FRYOLATOR i 1 ' , _ , 11 I ' 1 T E 1 t 1 FURNACE GENERATOR a GRILLE I i 1, 1 .. k 1 ; m 1; I (`n INFRARED HEATER I F 1 �! I-' LABORATORY COCKS il _ � . 1 MAKEUP AIR UNIT l li -1 E. li i 1` J I OVEN ' II IE 1 `I( 4 �; i VT, POOL HEATER a ROOM I SPACE HEATER 1 ", C ' ��' ROOF TOP UNIT .� I i € /L 4 `_ ' ..._ TEST UNIT HEATER ,: 1i 1 1 i i ` , i >' , it i # UNVENTED ROOM HEATER , € I WATER HEATER 1. ir, OTHER!GAS PIPING i -a 1 tI it..,f € , 1 m 7-1ami il INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I.... NO .,' I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L'....j OTHER TYPE INDEMNITY BOND 1_„,. 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 ,„,,, 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 accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (/ ,t/ • / V PLUMBER-GASFITTER NAME 1 STEPHEN WINSLOW LICENSE#I 12298 I SIGNATURE MP D MGF L JP LI JGF',71 LPGI Lii CORPORATION i 1,,,J#3281C 1 PARTNERSHIP _ I# 'LLC .-#� ti COMPANY NAME E.F.WINSLOW PLUMBING&HEATING I ADDRESS 18 REARDON CIRCLE CITY 'SOUTH YARMOUTH I STATE I MA ZIP 02664 1TEL$508-394-7778 FAX i 508 394-8256 i CELLI NIA =EMAIL;INSPECTIONS@EFWINSLOW COM