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Home My WebLink AboutBLDG-22-004185 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK yl CITY YARMOUTH MA DATE January 26,2022 PERMIT# BLDG-22-004185 JOBSITE ADDRESS 9 Vernon St OWNER'S NAME MICHELLE GRAVELINE/GRAVELINE TRUST G OWNER ADDRESS 9 VERNON ST WEST YARMOUTH MA 02673 1 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 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 1 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 ❑ 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 Scott Dugas LICENSE# 16845 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: SCOTT DUGAS PLUMBING INC. ADDRESS. 85 Anne Rd., CITY Eastham STATE MA ZIP 1032642 TEL FAX CELL EMAIL SCOTTRDUGAS(a YAGHOO.COM S310N M3IA3N NVId #11WN3d $ 33d 111N213d 3H1 SV S3A213S NOILV3IIddV SIH1 oN saA S31ON NOLL3 dSNI 1VNId AINO 3Sf1 N0103dSNI NOd 30Vd SIHI S310N NO1103dSNI SVO HOu1ON U ' _70 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM-GAS FITTING WORK 1 j A,=r, ..- tul j_ CITYL._ a t t, _......_ MA DATE I__/as -,_I PERMIT# ,. - 4`'' _ JOBSITE ADDRESS q j/ev' oc _5 •eel -. OWNERS NAME /tit Fci a C1- &ravel�v, OWNER ADDRESS _. 1TEL8-27— 44661FAXL TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL fl RESIDENTIAL tO PRINT CLEARLY NEW:0 RENOVATION: [1 REPLACEMENT: Li PLANS SUBMITTED: YES 7 NO ,.�. APPLIANCES 1 FLOORS-I BSM 1 2 3 4 Ell 6 8 9 10 11 12 13 14 BOILER i ;, l _ 1- — 1i1 '.___:�._: r BOOSTERji t t _. _ _ •I- •1-�- Mg.' CONVERSION BURNER 111_ i ��0I - Mf .um Millt -, " 1111111111111111. COOK STOVE '' 7 j�j ,� __.__-,j - ;j '- DIRECT VENT HEATER I l 1111111 ! - -y1I f mi 1 DRYER Ma LTM3iIllitriMMSIIMIPIIIIEIOMIILM. L1M1MMTIO _ - - . - FIREPLACE Min �-. _ ;_..-.-1` -_-..._�.__. W` 1 UN M FRYOLATOR ( M' I i_z - i MMIN FURNACE �iM � _ - t. �W. I�Ii� GENERATOR `� E Z ..._ _ �.�, ilinuni____:ra,,,m GRILLE �� I ? �i� -1 f' M I . .. . NM INFRARED HEATER �I.�. _ tl s. �� -----_. �--- -.-.�.----- -----� ;,-----�I LABORATORY COCKSWig11111:araln==!Ipt- 3=MAKEUP AIR UNIT _ i - - OVEN M- M��-_ IML POOL HEATER ' 1 yr_ j _..1_.ilic `. _u__ ;z ... �, � ROOM /SPACE HEATER I; n_ _ 'L -' ,� -y` - --Ji 1 ` , ROOF TOP UNIT - - - ' _ -- ` 4' '' - i- _ isiiingli TEST - �,� __ ,� i f ' UNIT HEATER .. .. -.. - '. �-- 111111 UNVENTED ROOM HEATER '_�.� 1 _. . i . , . -- ` o i M WATER HEATER .„s,_ ,i .4 AM..Olt7 �_ 1 ME OTHER 1 _ _ �__.- -i_mil_...„,. I,�. M 7! '',1 aiillit1WIMAIMIlini 1 — :111111:mnitimi 11111iiii : .MI'lliONIIMEM11111.111.111111 Mit INSURANCE COVERAGE I have a current liability insurance policy or-its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 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 - _I AGENT 1 I 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 Pe ' t vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I S t+-b cS _ - LICENSE #Iggkr-iii IGNA RE MP MGF[J JP 0 JGFO LPG! ! • 1 CORPORATION 0#10OtS5.2t51! PARTNERSHIP i le I LLC L#I COMPANY NAME:. Scrit01,30, vw.yD�t15 -r+nc , ADDRESS L at- Ann e ita . . I CITY , Ele -t ".) .x ,. ��_ 1 STATE /10 ,ZIP, oz6 Li a _1TEL I. 5a :-Tr,_8 ._, 7`t3i- _ ,_ I FAX . ._.._... _ _,.. ..,_. CELL oral -Ns" EMAIL SCQ 2 4 Yo,.\Aco • COw .�.