HomeMy WebLinkAboutBLDG-23-006016 i I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
•UCITY YARMOUTH MA DATE May 01,2023 PERMIT# BLDG-23-006016
JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 13G OWNER'S NAME SCHOENROCK PAUL P
G OWNER ADDRESS SCHOENROCK KAREN 268 FOREST GLEN WEST SPRINGFIELD MA 01084 4 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 111
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/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 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 !Craig Bishop LICENSE# 15101 SIGNATURE
MP❑ MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME: !HIGH EFFICIENCY LLC ADDRESS. 1378 Route 130,
CITY !Sandwich STATE MA ZIP 025632342 TEL 15088253695
FAX I CELL ! EMAIL salessupportt7a,hiph-efficiencyllc.com
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
6.--C,
RECEIVED
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERF I R G WORK
=_ i,_ 2023
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� BUILDING DEPA' „
JOBSITE ADQRESST OWNER'S NAME`s.1► 1%1' t
GOWNER ADDRESS r7El 1 :FAX'. t
TYPE O OCCUPANCY"TYPE COMMERCIAL • EDUCATIONAL 0 RESIDENTIAL
PRINT
C'E 'Y NEW:Lj RENOVATION:U REPLACEMENT: PLANS SUBMITTED: YES 4 NO Q
APPLIANCES 1 FLOORS•-•} BSM 1 2 3 4 3 4 7 8 9 10 11 12 13 14
BOILER ' » IIENE '.• ,•� -1:_ — '
BOOSTER i' w ! '! I `I
CONVERSION BURNER °I ! , �I, ��i'. �.__. I
COOK STOVE -
DIRECT VENT HEALER iaR1IIi =i
FIREPLACE Imo' . ,_.,;•,_ _ __ y.._,i kW*
FRYOLATOR - _ I -.•
"
FURNACE 31 i
GENERATOR I _�� :I
GRILLE 1�' ` 1, €'_ - 1' 7IIl;=yl .
INFRARED HEATER RIME ill '! WIER ;
LABORATORY COCKS ��IMi I _ —Alt
' MAKEUP AIR UNIT N: , '
OVEN ^i.___..j, s' ,,.�..� 1 .' ml�;"nf3:1
POOL HEAIhk. _ ,A ;, _1 i i� .I
- '� �_:
ROOM 1 SPACE HEATER i M. ;I,.„, i. '
ROOFTOP UNIT �t• g :i .�1 !
ITEST i.�!' �m�z--J'..
UNIT HEATER �1 _ :�- 9
UNVENTED ROOM HEATER ,m 'I ' .'� s
WATER HEATER iu. , -.._' i i `; ,,
OTHER s I. 71
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� 11. .._. . __w,. 4 • -:•J....,., .......»_ ..._.._ 'I� --.-� ._.... I...— I
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~INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L''NO L;
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY IE OTHER TYPE INDEMNITY 0 BOND
OWNER'S INSURANCE WAIVER:!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 Jj, AGENT E_
SIGNATURE OF OWNER OR AGENT
I hereby certifythat 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. C'el 0 ---�— -.
PLUMBER-GASFITTER NAME Crai BIsho l LICENSE#I151g1 SIGNATURE
MP[] MGF 0 JP L JGF i J LPGI jI CORPORATION I,j#I 5 PARTNERSHIP #_ s„,„1 LLC #
COMPANY NAME:iHIgh Efficiency U ADDRESS 1378 mute 130
CITY •Sandwich - c STATE L Ma ZIP E-02563 TF1'
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1 I salessu ort hi h-efficiert Ilc.com i
g CELL EMAIL- PP @ g c1'
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