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HomeMy WebLinkAboutG-18-6313 PEW 071-ehOld MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY YARMOUTH MA DATE May 10,2018 PERMIT# BLDG-18-006313 • �Ift� JOBSITE ADDRESS 6 WILD HUNTER RD OWNER'S NAME VANCISIN KENNETH J G OWNER ADDRESS VANCISIN CHRISTINE G 6 WILD HUNTER RD YARMOUTH PORT MA TEL 02675-1248 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO© FIXTURES FLOORS—. (BSM 1 1 I 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 • GENERATOR . 1 _ - 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 Jiabilitv insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NOD 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 Herbert Bell LICENSE# 11953 SIGNATURE MP© MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: HERBERT G BELL ADDRESS 22 Main St, CITY Orleans STATE MA ZIP 026532454 TEL FAX CELL EMAIL kevinasnowsfuel.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE 5-7-18 PERMIT# BL1b6 "/6 0063/3 JOBSITE ADDRESS 6 WILD HUNTER RD OWNER'S NAME VANCISIN GOWNER ADDRESS TEL 508-255-1090X14( TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:® RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS–' BSM 1 2 3 4 5 6 7 I 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR X GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT -- ^ OVEN POOL HEATER C' ROOM I SPACE HEATER RESFTOP UNIT ';AY 1 0 2018T T UNIT HEATERpqP� arY UNVENTED ROOM HEATER ® M — - WATER HEATER "y — OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO ❑ 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 0 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 complia 'th a Pertinen •rovi '. th- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �', , Q/�' islet�/ PLUMBER-GASFITTER NAME HERBERT G. BELL LICENSE# 11953 SIGNATURE MP® MGF❑ JP[ JGF 0 LPG]❑ CORPORATION IN# 4006 PARTNERSHIP 0# LLC 0# COMPANY NAME SNOWS FUEL CO ADDRESS 18 MAIN ST CITY ORLEANS STATE MA ZIP 02653 TEL 508-255-1090 FAX CELL EMAIL KEVIN@SNOWSFUEL.COM J470 it1179 7zi17 cfro ',I Div c--749 1/12d