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HomeMy WebLinkAboutBLDG-23-002089 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 19,2022 PERMIT# BLDG-23-002089 li JOBSITE ADDRESS 25 STRATFORD LN OWNER'S NAME MAURO EUGENE C TRS G OWNER ADDRESS MAURO CAROL A 25 STRATFORD LN YARMOUTH PORT MA 02675-1546 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 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 Richard Bartels LICENSE# 11845 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# Lc❑# COMPANY NAME: RICHARD D BARTELS ADDRESS. 7 PLEASANT PARK CIR, CITY HARWICH STATE MA ZIP 026452017 TEL FAX CELL EMAIL bartelspha(Scomcast.net 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 �'r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORMGAS FITTING WORK r .*' ::: '` V t E) ��L MA DATE /r' l '.22 PEF- MIT ; 23 Zo89 . -.._ . . . .. JOB TE 'DDRESS- Sri/AO/2 044 L/1/ OWNER'S NAME /li/f e- 6 p G17 20aviq R DDRE SS S ?,9 TEL --TYPE P. FAX I - u i t-ii E NA��1PCIIITAI CY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL NEW: z' RENOVATION: ] REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO E---- APPLIANCES FLOORS-4 SSi 3 � �1 25 6 �' 9 'I'I 1� I� 1- BOILER '- 7 1�� BOOSTER CONVERSION BURNER L COOK STOVE _1 DIRECT VENT HEATER DRYER FIREPLACE FRY OLATOR FURNACE GENERATOR. GRILLE INFRARED HEATER LABORATORY COCKS —� MAKEUP AIR UNIT • OVEN POOL HEATER • L_____' ROOM I SPACE HEATER ROOF TOP UNIT 1 TEST _ . UNIT HEATER UNVENTED ROOM HEATER • f (WATER HEATER - J OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ello ❑ I (F 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 waives this requirement. ) CHECK ONE ONLY: OWNER D AGENT ❑ .- SIGNATURE OF OWNER OR AGENT 7.!: 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 and that all plumbing work and installations performed under the permit issued for this application will be in compii e it all ertinentpro risi n ofthe knowledge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `U PLUMBER-GASFITTER NAME LICENSE ;t//$9S- SIGNATURE MP 0 MGF E JP ❑ JGF ❑ LPGI El CORPORATION ❑ 4 PARTNERSHIP ❑ # LLC COMPANY NAME It?4f "7441 ADDRESS 7 /JL FAS-44‘7"- /___. _____e4/-__:c_________e_cj CITY #ditc.t4e-6e STATE /044 ZING -91- TEL . a**&',./-'pV.2..PP FAX CELL i-i ' V Z!7 EMAIL ROUGH GAS INSPECTION-NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT ft PLAN REVIEW NOTES