Loading...
HomeMy WebLinkAboutBLDG-22-002983 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK xq BLDG-22-002983 I CITY YARMOUTH MA DATE November 23,2021 PERMIT# U s JOBSITE ADDRESS 8 JOSHUA BAKER RD OWNER'S NAME (Rosa Hernandez G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES 0 NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 El 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 (Robert Lalime LICENSE# 13701 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: 'ROBERT C LALIME I ADDRESS. 1575 Main St, CITY IMashpee STATE MA ZIP 1026492054 TEL 1 FAX CELL 1 EMAIL 'none ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES Z MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - n= f CITY OV 1'1-- Zai 7 '-------11-0:-;' _.l_ ��,._.._.__-�.� MA DATE � ��+ PERMIT# JOBSITEADDRESS` .o,._ 4s o� P4 (sQ -[ S�.OWNER'S AME ' e9S/-� (d(36��^��*2 I . GOWNER ADDRESS _ _ TEL FAX` j TYPE OR OCCUPANCY TYPE COMMERCIAL;.„( EDUCATIONAL j A,/ RESIDENTIAL PRINT �e CLEARLY NEW: a RENOVATION:.:.J.1 REPLACEMENT:�3 PLANS SUBMITTED: YES D NO L( APPLIANCES 7 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _JJ_1:-.-_J___J.J— _____1._____I--I—1______I__I_____I—J—1 BOOSTER -J—J__L____I , I.I—1'__I .—f— — _J CONVERSION BURNER f:__I t i_____1!_____I._ I_J.____J!__ -_j COOK STOVE __1__�'—I—.I_—I I_1:—J_._J—1-1—} —1 DIRECT VENT HEATER _____J,__I._I_I__ t • i._J_�y f —_f.—_ 1:-_- -___I:___1_1 DRYER• :_3 I_-1--J I,:-.. . .l - 1—J--1 ...._ I- I._ ___I—1 FIREPLACE -_1. 1 LLJ_ I_-_l;_J____J 1_:__J .- __J,`__1 I i_J.... _1 I_J FRYOLATOR I : _I:____I _._1_i_1,_—I,—1_.._!�.1—1 0 FURNACE _ ....__1: :_:1_1_ _ _—I -_1- I: !I-_-__.__J- . I i : . _J—1 ;=i1 1. . _____I : GENERATOR 1R ! 3 t I __J I_.__.1_.__!_1_I_J_____I—J___ GRILLE ___.1_._.J;_,1 . .- I�I _-i,__._J,----1'-1----.1_-1___-I:._I___1.____J INFRARED HEATER -__J_1_1.-1. 1 -�_-[-J i _J'� I i LABORATORY COCKS I__:_i _.i I . I._1_ I - 1 . . . _J r__I_.__J.__J___J__J__I it MAKEUP AIR UNIT 1 I.....__ I'_—I_._1__I I___J___I j. _ —1_._1___I.__-1 OVEN - I��I i I:. i,__1_.._.J I �._._! i'_.._.J-J______I i I . POOL HEATER .J� J_�._!—J.- ! ___ i i __l�1 J ! _____I.J ROOM/SPACE HEATER _ i ;_�.I .. I i t__ I_ I 1 J . I I�. I I- I ROOF TOP UNIT ,_i i r. I I ► i—I... I—j - - 1__ J _ TEST I 1 !_ I __1 i 1 i I I- I I UNIT HEATER I I I .__I - ____J __I_-_J_ J I___J: :,J UNVENTED ROOM HEATER I ' Y I 1—LI_-J-L---I i_,_j�_.I__ J ___j___I WATER HEATER. . 1 i'... ... I I�_1—I.�____J._.._,I I I___I+1 I s OTHER ' 1___.1 I. 1 _J1___I 1. _I___ ____I I___I____ 1 _1 � I J I i I I —1 I_J-J__I . I-J _1 '.__I_J .^J kip _ . . _ I 1 1 I__V.1 __J--J___I _I i—f____j_,_7_, 1 C - INSURANCE COVERAGE _ kI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LI NO • I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 11 OTHER TYPE INDEMNITY _i BOND Ii 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 :_ii AGENT .__I 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 a. .to • e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian•= -h -11;- n rovision of the Massachusetts State Plumbing Code and Chapter 142 of theGeneralLaws. Irl. /3-7,r)/ . (O PLUMBER-GASFITTER NAME T�� v 2 Z A 'T i i � LICENSE#p_� SIGNATURE MP 1_71 MGF a_1 JP JGF' LPGI CORPORATION-(#` 1 PARTNERSHIP L# LLC:_(#; 7. i --COMPANY NAME:.-6 �j✓v1.t t/V 1 G -- -Y t.ADDRESS 5 I �... [cn/ -5 j -- --- CITY . .tazgi....(. il..gW�c3C3..... ... _ -... I STATE MAIZIP 0 26Ci?1TEL 3- 15-a9g-U 7Y i FAX ( CELL: [EMAIL' F C F I V E D F 1 NOV 2 2 2021 1 t3UiLCKl ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT D 0 FEE: $ PERMIT# PLAN REVIEW NOTES • ‘&1Si M