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HomeMy WebLinkAboutBLDG-21-004247 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 29,2021 PERMIT# BLDG-21-004247 Ii_ JOBSITE ADDRESS 10 BASS RIVER TERR OWNER'S NAME BOLGER JAMES V G OWNER ADDRESS BOLGER MARY ANN 25 WORCESTER RD PRINCETON MA 01541 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: m 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 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 I 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © 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 Daniel Rossetti LICENSE# 15222 SIGNATURE MP 0 MGF ❑ JP 0 JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: Daniel N Rossetti ADDRESS. 19 HYDAWAY LN, CITY DENNIS PORT STATE MA ZIP 026391004 TEL FAX l CELL EMAIL L 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 APPUCATION FOR A PERMIT TO PERFORM GAS FITTING WORK . t GTY 1 _ 'f R�10��-1 MA DATEZo 1 PERMIT# 31-1)6a-/-Oav y/7 -7 JOBSNTE ADDRESS L ISO ligl _ IIs. �' C.tom I OWNER`S NAbE G ______,,.___] G OMER ___1 TE - '9 - its b FAX , J TYPE OR OCCUPANCY TYPE COM ERCIALEl EDUCATIONAL® RESIDENTIAL LEK PRINT CLEARLY NEW1"RENOVATION:El REPLACEMENT:® PLANS SUBMITTED: YESEI NO07. APPLIANCES Z FLOORS-' 9SMt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 I JUN BOOSTER r.1.1111111110,MI r 111111.1 011111111111111111 WIIII MIN 1 r � , CONVERSION BURNER caw STOVE ...,Ileil /Waal" E an R RIIIIMMI.ams DIRECT VENT HEATER mow Milli MN IMO MI INK all INN MIMI MX .,. 9,i`- :.,r ,. DRYER _ FIREPLACE _ __.vAM 4 - FRYOLATOR OM l IMMIX 1!Ma _ OM FURNACE OM 111111 a:OM MI MK NS :.A; . - , GENERATOR Y, s:,t• Il A_ MO Mg 111111111.1111111 R_OW--MR. _ GRILLE NMI um"�. INFRARED HEATER _ , LABORATORY COCKS i _ = OM NM MAKEUP AIR UNIT WNW _ Mr-.WI 01.10.._W OVEN MIK NW MMI; OW O W, mg POOL HEATER NW SW NM OMlifties'sinumill ROOM/SPACE HEATER —Mg M MN Mg IIIM NMI.I M; MI J M AM ROOF TOP UNIT OM 01–le'M 1.110101 WPM' TEST Mai MN ilii NMMg PIO NM AM OM MI.MR Inisum low sou UNIT HEATER m I IM`_ UNVENTED ROOM DATER MK NMI I!MIMI OM MM.MIMI ON MI O MN NMI IMO MI' . -' WATER HEATER — IMI PM int 111111111111111111111111111111.111111111111 OTHER -- AM am umAmow al w v -_ starlicigt ilii=Wiminillitlim=Wain, RIIIIRRENRIIIRRNEWICIES .. INSURANCE COVERAGE �;,/ I have a current Milky insurance policy or its substantial equivalent which meets the requirements of MGL SS. U I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i _ UAMLITY INSURANCE POLICY 0 OTHER TYPE IN DEMNITY Q BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage requirediby Chapter 142 orthe Massachusetts General Laws,and that my signature on this permit application skes this requirement. - ,v , `q R ry _ CHECK ONE ONLY: ESR l AGENT .; SIGNATURE OF OWNER OR AGENT -- I cerlify that alt of the details and information I have submitted or entered regarding this application are _,,...:. . ....:,1of my knowledge and that aN plumbing wait and installations performed under the permit Issued for lids application will be in—, , ' '•,of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, PLUMBER-GASFITTER NAME bold 0 SS CSE#� SIGNATURE MP MGF 0 JP Q JGF® LPG'0 CORPORATION ]PARTNERSHIP D1 LLC®# COMPANY ► C• PL.Q/13 & ACORES'Sl , ,B 3 9 1 CITY - IrN/J�C _ - __t STATE yJ ZIP 66Q JTELL cot-_ ,-,4�0 I FAX MUM CEL___-__ _JEMNL utA 61[l(6.W�G lAaF,,_ ._C&'1 _ ___ ____ __I r Vi