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Home My WebLink AboutBLDG-22-001152 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` BLDG-22-001152 � jy� CITY YARMOUTH MA DATE August 31,2021 PERMIT# W JOBSITE ADDRESS 7 TAFT RD OWNER'S NAME PELLEGRINO JOHN J JR TR G OWNER ADDRESS PELLEGRINO MARGARET F TR 106 DOW AVE ARLINGTON MA 02476-7142 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL 0 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 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:gas piping for meter 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 CHECK ING 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 requiremer t. 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 Couto LICENSE# 15856 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MARK J COUTO ADDRESS. 103 LAKE SHORE DR, CITY BREWSTER STATE MA ZIP 026312429 TEL FAX CELL EMAIL markicoJtowahoo.com S310N M31A32H NVId #111Al2,13d $:33d ❑ ❑ 111NH3d3H1SVS3A83SNOI1VOIlddVSIH1 oN sex S31ON NO1103dSNI 1VNld AINO 3Sfl N0103dSNI 80d 3OVd SIHI S310N NO1103dSNI SVO HOf10H ;��', MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1}j•—_erg.F- rf , ? ro i` CITY MA DATE gt31' "`I PERMIT �': I JOBSITE ADDRESS 7 7' FT 'd OWNER'S NAME JQ`t rJ Pe f'efr r iv o OWNER ADDRESS TEL FAY, TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL PRINT ❑ RESIDENTIAL Yi CLEARLY NEW:❑ RENOVATION:N REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ i APPLIANCES 1 FLOORS-4 BEM 1 2 3 1 5 fi 7 3 9 10 11 12 13 1fi BOILER — BOOSTER _ CONVERSION BURNER i COOK STOVE l DIRECT VENT HEATER { I-1 DRYER, 1 FIREPLACE FRYDLATOR i _____I 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 1---- WATER HEATER OTHER r GL~C INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of 1111GL.Ch.142 YES EKIO ❑ l IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ 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 wives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT c:'�� I hereby certify that all of the details and information I have submitted or entered regarding this application ar:-rue . d accurate to the best of my knowledge `k- and that all plumbing work and installations performed under the permit issued for this application will be in 'omplia a with all Pertin prow ' n of the �• Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# //..5.449 SIGNATURE MP MGF❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME IV 4-14 'FO P LD 4 ('fir ;7vC ADDRESS l0 3 Cr,_ u-e S k D✓ CITY STATE Ally ZIP 0 Zfo 3/ TEL FAX CELLS 4rf5-`G(K s EMAIL MA"j Cc'u-47) Ce "0 k09<< ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT • ❑ ❑ FEE: $ PERMIT#I PLAN REVIEW NOTES