Loading...
HomeMy WebLinkAboutBLDG-22-005438 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK E CITY YARMOUTH MA DATE March 29,2022 PERMIT# BLDG-22-005438 r li_`3e JOBSITE ADDRESS 54 BARNBOARD LN OWNER'S NAME Rick Sands G OWNER ADDRESS 54 BARNBOARD LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ID PRINT CLEARLY NEW: 0 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR GRILLE 1 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 1 OTHER DESCRIPTION:increase main 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 Troy Gilbert LICENSE# 25383 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: TROY J GILBERT ADDRESS. 39 STATION ST,39 STATION ST CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL katherineac,oastalphc.com S310N M3IA32I NV1d #11W213d $:33d ❑ ❑ 111%13d 3H1 SV S3A213S NOI1VOIlddV SIHI ON seA S310N NOI103dSNI 1VNId AlNO 3Sf1210103dSNI 2I0d 39Vd SIHI S310N NOI103dSNI SVO HOf102i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -7',„ f CITY Yarmouth 1 MA DATE 03/21/2022 PERMIT# 22 - S 4 3 8 JOBSITE ADDRESS 54 Barnboard Lane OWNER'S NAME Rick Sands GOWNER ADDRESS 261 Elliot St Chestnut Hill MA 02467 _ TEL(617) 590-0406 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:,,,,j RENOVATION:EJ REPLACEMENT:0 PLANS SUBMITTED: YES Li NO21 APPLIANCES 7 FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 ' 1 .. _11 L 1 :(. I I _ . ( BOOSTER t 4 tI t. I). . ;I .. ._ CONVERSION BURNER L I l� COOK STOVE j 'I 1 j if t `l DIRECT VENT HEATER L J IL • .l .. -U.. - . i_ DRYER L._ ' '4 (i II ( ;I ' I. 1I. , 11 I I FIREPLACE FRYOLATOR FURNACE J GENERATOR I , _, . �... _�_. w . . _ __ ,i_._., 1 - GRILLE L ' a1_ �i F J . _. _ I _ .' INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN I POOL HEATER , _ . ROOM/SPACE HEATER ROOF TOP UNIT 1 l TEST ; _ ;i UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I Upgrade Existing Gas Piping 1 ?' OTHER _.. _ 1 to 1 114"Black Iron Piping To Accept New BTU Load �� I i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES L NO mj I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND iLI 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 Lj AGENT Li 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# SIGNATURE • MP LI MGF ! JP Li JGF al LPGI aj CORPORATION LI# y PARTNERSHIP 0# LLC[,,�# _ COMPANY NAME: 'ADDRESS CITY STATE ,ZIP ITEL I FAX[ I CELL ',EMAIL