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HomeMy WebLinkAboutG-18-5593 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK BLDG-18-005593 CITY YARMOUTH MA DATE Apr106, 2018 PERMIT# ,,.-- JOBSITE ADDRESS 10 WOODBINE AVE OWNER'S NAME GEORGE ELI G OWNER ADDRESS 7 ELM LANE MASPHEE MA 02649 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 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 • 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 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 0 NO© 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 Anson Celin LICENSE# 32655 SIGNATURE MPD MGC JP© JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ANSON CELIN ADDRESS 68 SUFFOLK AVE, CITY WEST YARMOUTH STATE MA ZIP 026731444 TEL FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTF+S Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ • FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _`Isl_ CITY ♦rN -Np MA DATE PERMIT# Rai / y r3 JOBSITE ADDRESSTOLLSe�,-1;;p.a A:re- . (OWNER'S NAME : hCact e\t GOWNERADDRESS q C\ \h -o `-11 -1 TEL .FAX' E IS TPTR OCCUPANCY TYPE COMMERCIAL;-( EDUCATIONAL 3 RESIDENTIAL CLEARLY NEW:,-, RENOVATION:21 REPLACEMENT:L13 PLANS SUBMITTED: YES ED NO I:1 APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER —I _I _____1.___7_1 J—J—J J _J J BOOSTER JJ—J_I__ -1' 'JJ '—JLL1 CONVERSION BURNER -_I_J J__I •_I._J, I ___1•___I_J _J•J J COOK STOVE J - I:___J- HHrH _J_J_1 _J DIRECT VENT HEATER J11- DRYER• I -- - I - FIREPLACE J JFRFURNACEYR ^_ —i 1-J = — J1 - J--I--J GENERATOR GRILLE J—I—1 J J _J i_l J J _J INFRARED HEATER ' J_IJJ'J J LABORATORY COCKS t J ' 'J I _J itMAKEUP AIR UNIT 111_1—J I __f _J OVEN _I ___11 OVEN POOL HEATER i__I____I J—J _ JR ROOM I SPACE HEATER MS.__L!—i® i. JI[l6 [aaa�MI ROOF TOP UNIT TEST n111=11.J_J114� rS ES1 J UNIT HEATER allIM_-JIM_le_Jl*1 4aI ntsIM UNVENTED ROOM HEATER • J—JMN J®J J__JCWMWayj l3 __I WATER HEATER__ aiPSIM _I�. i__i—IS MEIPIWIMJ. JOTERI • I _ I LJ1E _-J -J ___1___J tis ' • _ I-J . .I'__J-J J_I J T1_J—J._J J_J_I _.p rl_ _IL.LJ J J_!__J__J._J 1-LI J J _I INSURANCE COVERAGE FI have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES I0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY 3 OTHER TYPE INDEMNiTY Ti BOND Ei OWNER'S INSURANCE • a • . that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Gene .r t S .. signature on this permit application waives this requirement �46- CHECK ONE ONLY: OWNER ,I AGENT SIGNATUR e OWNER OR AGENT I hereby certify that all of: _detail -nd information I have submitted or entered regarding this application are true anaccurate to the best of my knowledge and that all plumbing work a • stallations performed under the permit issued for this application will be In complia . with all Pertinen}provision of the Massachusetts S -,- - - .Ing Code and Chapter 142 of the General Laws. (. PLUMBER-GASFITTER NAMEI Y t; ~cQ ,yi -,---1 LICENSE# SIGNATURE MP Ti MGF'J JPS JGF LPGI-a CORPORATION;,.(#7. - I PARTNERSHIP'...-t# -7 LLC._f#i —E COMPANY NAME' X n&_ n Ce in ---' ADDRESS ZC-7 Cr. ct;•; -60, T?s7 ---- -- -•-1 CITY Snm'fh �//16 '--• -------.. --._...---..- .. •-.�--- C sTATE/k7t1ZIP: Gucf [TEL._...-.._ f FAX' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No /�('&AL 649 aX THIS APPLICATION SERVES AS THE PERMIT 0 0 Perl_ /fes/ 6 Yew R C/� (//f FEE: $ PERMIT S /f>//" - `�j `/} / ! PLAN REVIEW NOTES `� /C• Lj� PL 7(.7 • • • i •