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HomeMy WebLinkAboutBLDG-23-006050 :� , _` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ...w -4, CITY (YARMOUTH MA DATE (May 03,2023 PERMIT# BVfLDG 23-006050 I� JOBSITE ADDRESS 114 HIGH GROVE RD OWNER'S NAME IAGURKIS FAMILY LLC G OWNER ADDRESS 14 HIGH GROVE RD SOUTH YARMOUTH 02664-0000 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES ❑ 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 1 • _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❑ 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 ICameron Natale LICENSE# 14600 I SIGNATURE MP❑ MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑#I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: I ADDRESS. 1200 Audreys Lane, CITY Marstons Mills STATE MA ZIP 1026482648 I TEL '5087753083 FAX I I CELL I I EMAIL I I '--'4" MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w ='ti a CITY YARMOUTH MA DATE 4/26/23 I PERMIT#,BZ13G"2,3-'O6O.P JOBSITE ADDRESS 14 HIGHGROVE RD OWNER'S NAME DREG BOTSIVALES ri ' GOWNER ADDRESS 14 HIGHGROVE RD 'TEL 508-367-8700 1 FAX I w.n TYPE OR OCCUPANCY TYPE COMMERCIAL w_ EDUCATIONAL RESIDENTIAL..�i PRINT �_ CLEARLY NEW: J RENOVATION: .,w.= REPLACEMENT: ! PLANS SUBMITTED: YES___I NO_'J APPLIANCES-1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER ---_ .1 _____I ___„1 ___J __I __J _._€ ..__I _.__i _ „I . ..,_1__I ___I__. 1 aN. i .__I ____ _. 1 _.___I .w_ j „_....:1 .____J __ ._...w, . _ a.___.._ ___ .. __J_ . , ._.J CONVERSION BURNER ___ .., .J __r_,_ __,1 ___I___ _...J ____.. _ ___—J ._.__...J �.._.j ___I ___I , _. ,_.._._I ___I COOK STOVE J ..,.__1 ____I __,,.-_J. _-. _I ____I ______I _... . _ J ___i ..__..l _,___3 _____I .,_._. d.. „ .t DIRECT VENT HEATER I __�.._ ...__.a� �._ .wJ"..�.._. J _._ .� ..J .m�n_,J __.„.„1 _..u ___ J . .__I _..._t..� V _____I _____J DRYER _ . ., .J __I ___I___I ____I . J ___wwJ __I_J.__,._... _. ,..l ____J _ I FIREPLACE .___I __I _.. _... .J .... ..�._.__I I _._.._.., I I ,.., t . ,.. FRYOLATOR __ _._J _J �__1 _, ._ .. ,._.. _„_, J _ ! m. _.. I .._ __€ ___,._ .._.___€w,.... .t. .. FURNACE GENERATOR GRILLE INFRARED HEATER .,,,.. I. I ,___.._ J ... I __; ___I .. . __J ._w_J .,,.___I _._.__I W,__„I .___I LABORATORY COCKS I 1 1 , _ , _._ _J __I _ _I _..._.'_ . J _ ._J .arJ __I I MAKEUP AIR UNIT __ .,J ,.___N.J _ i .. .J ___I _„ n_,_I ,I . _ _ __ _I ____I ___J . OVEN _ri.._..J ___I ___ I ___J _., ____.1 ___,J „_ I__J I____I. .I __J __... POOL HEATER ,_._..I____I ____J . ..I I _____I _.. . ___1 J;___u_I ___I . .J J _ ROOM/SPACE HEATER _ I ,__. _J J.._ _____I __.,.._J ___I __.J ____I ___I __._1 1,___..,J _. .. ROOF TOP UNIT __. ,J _. I .. _.. J J 6 _...J .. E ___I_... ..„11 TEST __.__ ___.11 ..,�. .__._.J _�., . I _____I_____I .__ ._.4 _......,J . .._,_? __II E C .I V .-�F D I UNIT HEATER __ ____I J .. ___J _____I ______I ____1 ..i _ .J ____I , . _.. I !._- ..r UNVENTED ROOM HEATER J I i J _ _ J ____J ___i WATER HEATER __...I _. I ,__w? ____I ___I ____I ._._J ,. __I .1...._.a._I !, I OTHER ____I _ ._,_. __. .J _,.._1.___J ._.__1. .J ..J.-�.,.,— _, .,., �3 ,._.._I A.�,_„ _.W,�..!___ __.I i B L17IN ' UEf(ARR ENT I � 3 J i J i — _.,,,...� ..,M.., . ..«._.� ._.. �..._.,_, ....w._.._I ,,.„,.,,._,...1 ..�..__..J _._�.-w.._I .___ 1 ._...�........ ,___._.; ____I ,...,._,..,. ., .».�,,, .I .....d �,,.�__�_I �,.�,.--,�I ... INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1_', NO ,,, I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _.i OTHER TYPE INDEMNITY I 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 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 P inent p vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME CAMERON NATALE LICENSE# 4600 IGNATURE MP :.. MGF v: JP JGF LPGI CORPORATION i s# 307 PARTNERSHIP # LLC i# COMPANY NAME: ROBIES ADDRESS 279 YARMOUTH RD CITY HYANNIS STATE MA 'ZIP 02601 :TEL 508-775-3083 FAX CELL EMAIL RACHAEL@ROBIES.COM