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Home My WebLink AboutBLDG-23-002593 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY YARMOUTH MA DATE November 09,202;PERMIT# BLDG-23-002593 �.1..'.� JOBSITE ADDRESS 190 FOREST RD OWNERS NAME Den Dinunzio G OWNER ADDRESS 190 FOREST RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES❑ 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 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 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 Jeff Crofts LICENSE# 16801 SIGNATURE MP Q MGF❑JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ADDRESS. 193 Holyoke St., CITY Ludlow STATE MA ZIP 01056 TEL FAX CELL EMAIL NONE ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El El FEE: $ PERMIT# PLAN REVIEW NOTES ' r 1 11 i _ ' CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1‘,,, , --.iYi , DIED 4tir_ - • 'ar our j MA DATE 11/03/2022 j PERMIT # _ 22 NOV 7J___K�E 4 ID' ESS 190 Forest Road j OWNER'S NAME Den Dinunzio I BUMCG-DEPAINKEVItQR SS Same I TEL 508-277-4231 FAX _ ___f YP ' OCCUPANCY TYPE COMMERCIAL V EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: V REPLACEMENT: PLANS SUBMITTED: YES V NO APPLIANCES Z FLOORS--► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I 1 _ I _____I ___ I I I ____I I _1 _I I -1 I BOOSTER ____I _.__J —J __I __—I_1 ___._I __I I= I ____I _1 1 CONVERSION BURNER I ___.__..1 _____J ____J _I I _1 _-1 1 --- I 1 ___1 1 _1 1 1 COOK STOVE !J 1 1 1 1 1 1, I I I _1 I —J _ ___J DIRECT VENT HEATER I ____._I 1 I I .—__1 I _____J .---_-J --_I I __I ---I __ I ____I DRYER _._J _.1 _.1 _. __J —J ______I J __I I _1 _I ___._J _-1 FIREPLACE I _._..__I I I 1 _.._I I I I I I I I . I FRYOLATOR _.I _._ _ 1. I __1 _..._._.J — I __I 1 ---.1 I —__1 1 I __J FURNACE _____J —__1 _1 _______1 _____I I --_1, ---1 —J ---J --1 ---J —1 I -----I GENERATOR I l i __—1 _1 __I _____a 1 _I I —1 I —.-.---I I 1 GRILLE I 1 I 1 ___.1 1 __-I I 1 1 ----J I ! INFRARED HEATER I I I I _ I _____I I I_____I 1 --I 1 _____J LABORATORY COCKS I __J __.__1,._.— I ___._J ___-1 I _1 _1 __I I __I 1 I I MAKEUP AIR UNIT I .____.I 1, 1 1 _._._._1, 1 1 1 1 J _ 1 I 1 OVEN I ....._._J ____.1 1 _1 I _1 1 _1 ____J __J _____J __I -----J I POOL HEATER I __ 1 _____1 1 _I _I ..-.—.I 1 1 1 __1 1 I _I ROOM / SPACE HEATER __I I ___1 I ___J ____._J __..—I 1 .--I 1 _1 I --.I 1 ROOF TOP UNIT 1 I ____.1 1 _I, 1. ___J I ___J, ___ ___ _I 1 __I TEST __1 I __I I _J _—_I __--1 I ____ I I ____I I ____I I UNIT HEATER _I I ____1 ____J _1 _1 ____I ____J,---_J —J ----1 ---- ----__I J UNVENTED ROOM HEATER 1 1 1 1,_1 1 _ 1 1, 1 I ______ ..I, I I I WATER HEATER I _1 I _I I ___-1 __.__._1 ______I _-._._J _1 _1 _____J 1 _I OTHER I I .._I __.___1 _1 1 __1 1 ..—J ____J —.__I ____-_J _____J 1 ---J I _l ___.._.,_J —1 1 _1 1 - 1 I —..I 1 __ _ 1 .—..I 1 I 1 1 1 _ 1 I . I 1 1 1 1 1 1 1 I .... I _ .._..I_ 1 _�_._I I —J I .__I _.____J _. —1__.—J _______1 _I 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 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 tr e a accurate o t• b:i o y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ian .th all • • ► nent rov. .ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Jeff Crofts ; LICENSE # 16801 SIGNA MP V MGF JP JGF LPGI CORPORATION V # ,. ,, s PARTNERSHI a # LLC # I COMPANY NAME: JSN Services, Inc. ADDRESS 193 Holyoke Street l CITY Ludlow i STATE MA ! ZIP 01056 J TEL 413-583-2227 I FAX CELL EMAIL