Loading...
HomeMy WebLinkAboutBLDG-23-006003 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK II'- CITY YARMOUTHk,, MA DATE May 01,2023 PERMIT# BLDG-23-006003 JOBSITE ADDRESS 8 ARLINGTON ST OWNERS NAME KURKER WAYNE TR G OWNER ADDRESS THE EIGHT ARLINGTON ST RLTY TRUST 1 WILLOW ST HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY CI BOND El 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 Paul Kelly LICENSE# 11689 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PAUL J KELLY ADDRESS. 70 SHOREWOOD DR, CITY MASHPEE STATE MA ZIP 026492817 TEL FAX CELL EMAIL paulna.kellyph.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK it3� CITY 1'Ll MA DATE 4 2 L 2 PERMIT# 6 av3 <i,� Ni(.�-u Jl JOBSITE ADDRESS /1 Aar ham(' 14 5 7L OWNER'S NAME c OWNER ADDRESS 4 Am&S Ivies r t. w✓ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL KJ-- EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT:ET PLANS SUBMITTED: YES 0 NO 0 APPLIANCES FLOORS—I. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 11 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 7- ROOM I SPACE HEATER j 'I ROOF TOP UNIT 1 TEST ._ .._.._ ' � UNIT HEATER i IFit UNVENTED ROOM HEATER WATER HEATER -U 1!_tietiwG rH K M E N OTHER B INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ir. ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY � OTHER TYPE 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. 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 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 LICENSE#��� Tcj " SIGNATURE MP v'MGF❑ JP El JGF❑ LPGI1❑ CORPORATION❑# PARTNERSHIP 0# tic❑# COMPANY NAME VA-I I ?v- ADDRESS CITY IA" nk STATE MIA ZIP DI(f)" TEL 50* S g / 0211, FAX CELL 1) a vet EMAIL 'Tcr v 14.1I Q o K\ c doh ROUGE GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY kINAL II ISPECT iON NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT ft PLAN REVIEW NOTES