Loading...
HomeMy WebLinkAboutBLDG-21-000184 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ; CITY 'YARMOUTH MA DATE July 14,2020 PERMIT# BLDG-21-000184 JOBSITE ADDRESS 1213 CRANBERRY LN OWNER'S NAME 'HENNESSY FRANCIS L G OWNER ADDRESS IMAFFEI MARIE 213 Cranberry Lane South Yarmouth 02664 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 434-5-3 �/ PRINT ❑ RESIDENTIAL III CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES 0 NO 111 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/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 _ _ _ OTHER DESCRIPTION:firepit/generator 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 (Michael Mcbride LICENSE# 19681 SIGNATURE MP 0 MGF 0 JP© JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: 'Michael R Mcbride ADDRESS. 11 Mayflower Ln, CITY 'South Yarmouth STATE MA ZIP 026644220 TEL 1 FAX CELL EMAIL MASSACHUS TT UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .wr e' R =" CITY ._ 4 u_ _ MA DATE:°/� f I PERMIT# 312)6 " eg/ODd 1 V JOBSITE ADDRESS, 7/ 3 `cf-I & L4OWNER'S NAME �,•,-Z1--,,,,, S� GOWNER ADDRESS 7 i I TEL TFAX` j TYPE OR OCCUPANCY TYPE COMMERCIAL.1_ EDUCATIONAL J Tit PRINT CLEARLY NEWgJ RENOVATION:J REPLACEMENT: PLANS SUBMITTED: YES; NO J APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ___J I:_____1,__._J_.___ —1__J_J__J_.1 t_J__I BOOSTER J 1. ! I 1- -1'_1-1__I.-1-j . . -____1 CONVERSION BURNER Ii s_ J 1 ._ I i I._1_J __1 1 ! J__I COOK STOVE _____1 .. _I 1-1—1 I.. .... .I .-J:_-1 DIRECT VENT HEATER I_J .__J; } __I_� ,__I 1_J_____I '_I DRYER _J—1-1-1 : 1 1 I_J 1 I I i _J FIREPLACE �_J�J___J__I___1__i_.._._.._1,__.f I_r J_.._.... .I �I_1-_1 FRYOLATOR _._ 1 i_1. -_4-._1.-I 1 1 _1 __ _1_-__1-J I I J -_I I FURNACE __I—1�_-1: I_moi _ . . I 1 ---' I GENERATOR - I I __! I 1_ I_ I I '; GRILLE __i __(,__I_____.f # ___JJ J' J._�__1_____I.___1 ____1_____J INFRARED HEATER -J______I1 _____I I_ j ..._ I _I ----._.1-1 _1__J_J i LABORATORY COCKS I 7.___ � •j, 1..__. j_____I, I l:__,__J_______1,_____I_______1,_____I_J_-1__ e J 1 MAKEUP AIR UNIT ii, _x..1_1 1 ___Jr l _I____.1 I 1: 1 it OVEN i ______I I I_____I__J _J I __J t ______4=72.177:47.: I_ POOL HEATER _1_�1___,.-._.1__1.�_1 i I_.__J_1 .4:,�, . 17 s ROOM/SPACE HEATER _ _M1 !_ 1 1___1_ _1_..__.t.____1 _1 s. __._,I _.r1 I 1 ROOF TOP UNIT 1_____I__„i_J '_._1_� 1,..._1 1�_I ii TEST i i 1 _r ____1 J __I__�.i i 1UL 1 1 1 UNIT HEATER _I 1 _ _I _______1__ - s___-_i _.._.1_ _.r.... UNVENTED ROOM HEATER _•_J 1 ? _ _____i ; _JI . ' DINS ` WATER HEATER _---- ---- -.._ _J__._T .. _,•.__�. __ I �1 1 ! _._1 I 1_j I OTHE \I--1 I ______I_______1 I_...1_. 1 J �I_..J ' . . /t- /:..7 O 1 I / 1__.I _moi I - i___J_____I . __! __.1_._1.�1_____.1_�J I__._.1__.J 1_a___1 I '-____.I_J 1..____I_ _1 _I_1_ �! i I I_ 1 i_..._J 1__1 i 1 1 _ i .._ _ i INSURANCE COVERAGE tI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 144410 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY J BOND 11 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 ;JJ AGENT :1 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 Ge raI Laws. 11 ger Tri I 7g PLUMBER-GASFITTER NAME (�+� LICENSE# SIGNATURE MP __I MGF j_-3. JP JGF A LPGI _J CORPORATION J# f PARTNERSHIP:1# I LLC #_. Y NAME: ill 01,/'jAq/ t ADDRESS9 /C 57-7-6 0,77 1,,eT 1 .,_ .._ . CITY G\-fL ( odifj11 STATE ZIP -L1 Z67- TEL .7 ' IO 2)7_7 FAX { CELL: 1 EMAIL S" ,/.�-- -- s NI_ n ys /[ , C 0 I 1., 6 �i ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMR 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES • y4 44i J t t' V i ' VSA (..C. C a