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HomeMy WebLinkAboutBLDG-22-005241 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 21,2022 PERMIT# BLDG-22-005241 r. JOBSITE ADDRESS 57 CIRCUIT RD OWNER'S NAME William Kennedy G OWNER ADDRESS WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:12 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 1 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 Andrew Leighton LICENSE# 16130 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ANDREW R LEIGHTON ADDRESS. 20 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL FAX CELL EMAIL halloilcompany(D.gmail.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 < <J a , OG - -_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r.�— n CITY J o AP13 i-c C)u MA DATE 3' I L{-Z Z pnivir# 'I-1` S Zti i JGBSITEADDRE S? ?Rec2/04 /?&(4/9 -wen NAIsJItE tee//l;cf `f'e.v?12eer GOWNER ADDRESS (Ue.S T TYPE PRINTO OCCUPANCY z"PE COMMERCIAL EDUCATIONAL RESIDENTIAL OLEARL•Y NE : RENOVATION: RFLACEEK'.: V - PLANS SUBMITTED: YES NO V APPLIANCES Z FLOORS— 13S,SM 1 ! 2 1 3 i 4 ; s I t3 7 I 8 S 10 f 11 I 12 r 13 14 BOILER ! ' • I 1 - 1 I [ i BOOSTER i .. i .• • • i I ! [ CONVERSION BURNER .t 1 _ l _ ! • t t I [ 1 { _ COOK STOVE [ I [ - I_ . [ - -I. 1 E i i i I i • DIRECT VENT HEATER [ -I ._. I [ r [ [ I DRYER I. I [ •[ i ? I I FIREPLACE i [ . [ i f I I [ [ [ FRYOLATOR ` ? 1. _ 1 [ [ f i . . _ [ - GENERATOR } [ i . [ i 1 GRILLE I t [ 1 tI • -I. INFRARED HEATER [ _ i • [ •_ • t [� >' �M' - - - MAKEUP AIR UNIT I I . [ . ! I I • OVEN ? 1 =# _- _- ? mi[ F i » . POOL HEATER ? _- I . . -' - . _ . __ . ROOM 1 SPACE HEATER I I ? _ I I . I . - - ROOF TOP UNIT [ i I _ TEST ! I i _ , ���M� I . UNIT HEATER —1.111 I i 11.1111111- UNVENTED ROOM HEATER t. illialliMill WATER HEATER - [ I l _ I111111111111111MIMINIIIMI. . _ OTHER [ [ I - I I [ • [ ' ummimaillomiimliiimmit INSURANCE COMA r- I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES :1/NO I IF YOU CHECKED YES,PLEAU INDICATE THE TYPE OF COVERAGE BY CHECKING THE ---OPRIAtTE BM BE.OW LIABILITY INSURANCE POLICY V OTHER -=INDEMNITY BOND • OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the i , rance coverage required by Chapter 142 of the Massachusetts General Laws,and that rmy signature on this pennf application : -_this requirement. CHECK ME•, : OWNER AGENT SIGNATURE OF OWNER OR AGENT • I hereby madly that aU of tfte details and info:Arr.ilen I have submited or entered regarding• :oPOrleaton are. --an -r- _ ,r� army kit ge and that a0 ptumaang work and Instatlerone performed ut�na paint ISSuad fart is Opp -__ - wfI the in .s pan— ,'F,-'�-,;%. •ru, • cite Massachusetts&aft Pttanbing Code and Chapter 142 at-the General Laws. • PLUMBER-GASFITi ER NAME ANDREW LEIGHTON LICENSE 16130-M INIP' SIGNATURE MP • MGF JP JGF LPGI CORPORATION { 373 G PARTNERSHIPLLC COMPANY NAME HALL OIL COMPANY INC. ADDRESS 435 RT 1 .. CITY SOUTH DENNIS STATE MA ZIP ( TEL 50$-398-3831 FAX 568-394-306$ GEL_ sw IL static cortparty@gmait.corn