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HomeMy WebLinkAboutBLDG-22-006779 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 23,2022 PERMIT# BLDG-22-006779 ''- JOBSITE ADDRESS I864&878 ROUTE 28 I OWNERS NAME DIGIOVANNI GERARD J G OWNER ADDRESS DIGIOVANNI JOSEPH 67 BAKER ST BELMONT MA 02178-4024 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: m 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 2 DIRECT VENT HEATER DRYER 2 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 3 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY 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 Ronald Hague LICENSE# 7636 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPG! 0 CORPORATION 0# _I PARTNERSHIP 0# LLC❑# COMPANY NAME: RONALD J HAGUE ADDRESS. 62 NEW BOSTON RD, CITY DENNIS STATE MA ZIP 026381901 TEL FAX CELL EMAIL ronhague(dcomcast.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 ll6 .01 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I Ft-P-------t Y T � ,;. h4r, DATE J`- , D PERMIT (c ?)`I 2C IT All RESS C>y -0,1�.r D k OWNER'S NAME Iet,t b, C., io ;hr�L, BUILD G DEF'RWMENTDI'RESS TEL bI) g3 is' • O$t4 FAX ByTypi7. nit,_-- PR T --- -!--6 TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[l CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ®. PLANS SUBMITTED: YES❑ NO APPLIANCESFLOORS—F Bsi 1 2 3 1 5 6 7 8 9 10 11 12 l BOILER I� BOOSTER CONVERSION BURNER 1 COOK STOVE a DIRECT VENT HEATER ' DRYER �_ FIREPLACE 1 FRYOLATOR FURNACE , i GENERATOR GRILLE J INFRARED HEATER I --_i LABORATORY COCKS . . . MAKEUP AIR UNIT -_ OVEN ; POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT --, TEST - UNIT HEATER - UNVENTED ROOM HEATER • WATER HEATER _ OTHER - 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT "i•• I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with P Went r ision of the 4jMassachusetts State Plumbing Code and Chapter 142 of the General Laws. l / PLUMBER-GASFITTER NAME -O ' ` {) LICENSE#t ) 6 3 GN URE MP MGF❑ JP ❑ JGF❑ LPGI ❑ CORPORATION❑#i PARTNERSHIP❑it LLC❑# COMPANY NAME IA OIC4V.D I. Oc ADDRESS (3. • t\ . _. (eS L '< cl- CITY O v., S J STATE IM IA' ZIP 0 a 4,3 ir TEL o$ —3 by —?t'l b° FAX CELL EMAIL fOAkL5LA a€ Co "•A CA.5\- ,'" I— TOUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES 'des No THIS APPLICATION SERVES AS THE PERMIT J FEE: $ PERMIT # PLAN REVIEW NOTES