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HomeMy WebLinkAboutBLDG-21-006913 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,'_, CITY YARMOUTH MA DATE May 28,2021 PERMIT# BLDP-21-006913 JOBSITE ADDRESS 21 TRUMAN LN OWNER'S NAME DONAIS JEFFREY A G OWNER ADDRESS DONAIS MARGARET E 56 RIDGE RD SOUTH HADLEY MA 01075 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 El 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. 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 Mark Moran LICENSE# 20786 SIGNATURE MP❑ MGF ❑ JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: (MARK R MORAN ADDRESS. 116 BRAMBLE BUSH DR, CITY 1FORESTDALE STATE MA ZIP 026441017 TEL FAX CELL EMAIL 1 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK )` sirim _;= i meq. :_►1_--y CITY WEST YARMOUTH MA DATE 5/06/2021 1 PERMIT# 6 `oa (09 13 JOBSITE ADDRESS 21 TRUMAN LANE OWNER'S NAME JEFF DONAIS GOWNER ADDRESS 21 TRUMAN LANE TEL 413-531-9953 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES 0 NO Ei APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ®®110.1®I NM 01.011il MN! BOOSTER Nina. EIMi1-1®1®(MINOIIIIIIION NMI CONVERSION BURNER !1.11[ ME SIMI 1® 0111111 11111111 1_IMMUNE MI NM 1..EN COOK STOVE MME11.111 DIRECT VENT HEATER INNr_OIM1N1.001_1Iiii1® NEI 11111111 DRYER I=Mg Mil= 1111111111111111®,11111-AMU NW= 1111111 FIREPLACE - - -I- FIREPLACE 'Mi.IME 1111111111111111 ION IMN11111111111FINN NMI FRYOLATORI® 00111.. ' I FURNACE N®11.11_[ OM 1 1IME MB GENERATOR -'-N 1N,INE!Mii Mili !®I.10I_I_ GRILLE MIME 1M 0.1 1EIII,NIS I®1®1® INFRARED HEATER ®®111.11® EN INN[MN;N®1_I■1IIIIIMIN LABORATORY COCKS NMI 1111111 INN NM IMMO 111111111111111 ION INN IEll MN ,111111111111 MAKEUP AIR UNIT MIN 1111111111111011111,11111111111 NM E 1IIIO MIN NMI lin MIN INN OVEN 0.0i.111.110[ME;®1OM ®�1�I �i■■�1�1■■t POOL HEATER NEI 1MNMIN 1111111 MN NEI III.III.ENMIN IIIIII EMI MIN I1111111I� ROOM/SPACE HEATER IIIIIIII w 1■t 1■N I ®0111..M.•r--MO 11E111 NIS 1E[MN ROOF TOP UNIT UM Mil E®NM--NEI ON 1- TEST Min INN EN MIN SINN 11111111111111 111111111111111 UNIT HEATER 111111111111 -111111111101111■11111 - -rNEMI-1■1111111111111111111 UNVENTED ROOM HEATER ®'NM 011.111111111111 11111111•1111 ill=MI 111111111•11 WATER HEATER ®EN w EN'MOO MEI 11111111111111111111'NIS'MN INN 111111111 OTHER 1®INN 1111111,111111 111111111® MN NE SIN 011111 EN OM 11111111 IMO OM INN 1111111111111111M AIME!®--I_h■SMNIMIN1'®I111111111_ 1-,_ MNOMEN i EN ON- -Ell r®rOi- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E OTHER TYPE 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. CHECK ONE ONLY: OWNER ❑ 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME MARK MORAN LICENSE# 20786 SIGNATURE MP El MGF❑ JP 0 JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME: MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934 FAX CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.COM 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