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HomeMy WebLinkAboutBLDG-23-005341 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 29,• MA DATE March 2023 PERMIT# CITY IYARMOUTHBLDG-23-005341 JOBSITE ADDRESS '481 BUCK ISLAND RD UNIT 12BC OWNERS NAME IPAUL BABINEAU G OWNER ADDRESS 481 BUCK ISLAND RD #12B WEST YARMOUTH 026730000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 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/SPACE HEATER ROOF TOP UNIT TEST 1 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 'Ronald Conte LICENSE# 115696 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑#I J PARTNERSHIP ❑# LLC ❑# COMPANY NAME: 'RONALD M CONTE ADDRESS. '283 Cranview Rd, CITY 'Brewster STATE MA ZIP '026312241 I TEL FAX I CELL I EMAIL Ircontemechanical angmail.com a'.+ (�'SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORJ GAS FITTING�,s Y WORK CITY A O v �/ 1123 MA DATE PFRI,1frpe y 23 v6 ___3 Yi JOB'TE DDRESSg VC_ j S �� RP 7 j? B ILD �EPA•T T O �l�l �vCl� j OIMER'SNAME N_ I C�j21IP 8 Jo' GI OWNER 'DDRESS l�nd- t 7 G� S l N R 5 0� Z 3 TYPECAE OCCUPANCY TYPE COMMERCIALTEL 71 II FAX PRINT CLEARLY 0 EDUCATIONAL DI RESIDENTIAL[� NEW:❑ RENOVATION: ICJ REPLACEMENT:0 APPLIANCES e PLANS SUBMITTED: YES 0 NO❑ BOILER FLOOR =gyp® p©0® y 10 11 Is BOOSTER -�-- ® 14 CONVERSION BURNER -�---� -- COOK STOVE =��-�_ DIRECT R ER VENT HEATER -� = -_ -= FIREPLACE au...C----- - FURNACE C�= FRYOLATOR GENERATOR C_ NEM- --_ -- -- GRILLE - INFRARED HEATER ==_ ���_ LABORATORY COCl; -=- --- =- OVENMAKEUP AIR UNIT -__� === _- POOL HEATER ROOM(/SPACE HEATER • _ -= -- TESROT TOP UNITnonalliallin -�-- UNIT HEATER . . =�® ...._ .. - ® ��-•- UNVEIdTED ROOK!HEATER Nil S=-_ WATER HEATER 4 MNIIINNNINININIIIMENNIN �- OTHER -_ _-M_ _� EN111111111 NMI MUM _- - =IIIIIIIMNIINNIWNIIIIU= E I have a current liabiii insurance policy or its substantial equivalentwhich OvmeetsG the requirements of MGL.Ch.142 Y r-,� I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ES Lid Rt© ❑ LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by 142 of the Chapter Massachusetts General Laws,and that my signature on this permit application waives this requirement, p ''� SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ID AGENT El rb I hereby certify that all of the details and information I have submitted or entered regarding this application are true and and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Massachusetts State Plumbing Code and Chapter 142 of the General Laws. accurate to the best of my knowledge ,�'� Pertinent provision of the PLUMBER-GASFITTER NAME 'R 0 In 0.t(9k- Co 111-e LICENSE#)5b 76 , '" MP d MGF❑ JP[� JGF❑ LPGI El CORPORATION I]CORFORATIO # SIGNATURE P COMPANY NAME .M,C N t� PARTNERSHIP 0# LLC 0 M F c H AN 1 c A L ADDRESS Z 8-3 C rct '' 2 STATE 1 C'w r2 _ FAX f��: ZIP O Z CITY d rG w S � CELLSo�- z 3f--q�I � TEL L EMAIL h C-0 C