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HomeMy WebLinkAboutBldg-22-001688 Y' 3 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kXI— ':I BLDG 22 001688 rt — CITY YARMOUTH MA DATE September 23,202 PERMIT# <I JOBSITE ADDRESS 635 WEST YARMOUTH RD OWNERS NAME TOWN OF YARMOUTH G OWNER ADDRESS RECREATIONAL&MUNICIPAL I WATER DEPT 1146 ROUTE 28 SOUTH YARMOUTH TEL MA 02664-4463 TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 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 OTHER 1 OTHER DESCRIPTION:gas griddle 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 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 Al Cassano LICENSE# 9015 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: ADDRESS. 8 Fruean Ave, CITY S.Yarmouth STATE MA ZIP 02664 TEL FAX CELL 5087769536 EMAIL SIDt7a.CAPECODMECHANICAL.COM ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El FEE: $ PERMIT# PLAN REVIEW NOTES a. *� - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .14 et -1�L _, [Y f MA DATE'09/21/2021 PERMIT# �, � CITY YARMOUTH �� JOBSITE ADDRESS 635 W.Yarmouth Rd,W.Yarmouth,MA 02673 OWNER'S NAME 'Bayberry Hills Golf Course GOWNER ADDRESS 635 W.Yarmouth Rd,W.Yarmouth,MA 02673 TEL 508-394-5597 FAX{ TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:D REPLACEMENT: PLANS SUBMITTED: YES 0 NOV APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERiiii pm am imp BOOSTERi: E a sW .. CONVERSION BURNER ai ,,�� " u— i� COOK STOVEgm r_Eirmsouniamoso mum ` , iiiitarnt DIRECT VENT HEATER MIIIIIIIIIIIIIIMMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII11 ,11.111 M. DRYER FIREPLACEIMMII.III.a.IIIIIIIIIIIIIIIaaIIIIIIIIIIIIIrIIII.IMIIIII0IHIMIJIIIII OM FRYOLATOR FURNACE GENERATOR I 1101011011.01110110101 GRILLE l.__ j 1- I INFRARED HEATER :T_ LABORATORY COCKS MAKEUP AIR UNIT MAW iimigirinerapprimmumniummorm OVEN _1INII_E _ G POOL HEATER sautimmisotairmaitineriatuarmsormitiat ROOM/SPACE HEATER 1111.1111.111111111,11101111111111111111.1 11111111111.1.1111.111111111111111 ROOF TOP UNIT TEST IIINIIIIIIIIII IIII OMB Ms Iimicimmilig"am Ow o UNIT HEATER Miltiommirwisinamoismitimitimsommicauv. UNVENTED ROOM HEATER WATER HEATER . �_ _..._ _e_ _ _ �?—ON IMO 110.1 III.Mt OTHER Replaced_gas Imes/pipes ,Millnli ililliW1 1111111t IIIIII an �....i i to-2 I rills.. ,i 1 1101110.1.1.1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE 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. CHECK ONE ONLY: OWNER Li AGENT 0 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 comp!' nce with nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ~44t PLUMBER-GASFITTER NAME ALBERT CASSANO LICENSE# 9015 I SIGNATURE MP Li MGF L.3 JP'„ JGF LPGI Li CORPORATION D#13016 1 PARTNERSHIP #_ LLC LJ#LJ COMPANY NAME:I-CAPE COD MECHANICAL SYSTEMS,INC. -I ADDRESS l 8 FRUEAN WAY CITY (SOUTH YARMOUTH I STATE MA ZIP[02664 ITEL 508-776-9536 1 FAX L ]CELL 508-776 9536 EMAIL info@capecodmechanical.com