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HomeMy WebLinkAboutBLDG-22-004775 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE IFebmary 28,2022 I PERMIT# BLDG-22-004775 JOBSITE ADDRESS ITS-HALLOW BROOK RD I OWNER'S NAME DESLOGES RAYMOND J G OWNER ADDRESS 7 SHALLOW BROOK RD SOUTH YARMOUTH MA 02664 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ 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 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 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 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 LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 BOND ❑ OWNERS 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 at 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 Anson Celin LICENSE# 32655 SIGNATURE MP 0 MGF❑JP❑ JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑#I ILLC❑# COMPANY NAME: ANSON CELIN ADDRESS. 26 Capt.Blount Rd. CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL ansoncelinna.yahoo.com S310N M3IA32i NVld #1IINb3d $ :33d ❑ ❑ 11Wif3d 3H1 SV S3A2i3S NOI1VOIlddV SIHl oN saA S314N NO1103dSNI 1VNId KING 3Sl 2i0103dSNI 10d 3OVd SIHI S310N NO1103dSNI SVO HOflO I I $ i it ► a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1111111Y,- CITY l (if MA DATE Z-T�-w�� PERMIT # Z1` JOBSITE ADDRESS L:6I( - 1 t) OWNER'S NAME Liijr.4 � -v - `.X _ _4.4-b“,t, ,..., , G ____ OWNER ADDRESS I.. .L_ : t._ r TEL[: `7 L ,�jEa LAX L. _., TYPE OR OCCUPANCY TYPE COMMERCIAL[-1 EDUCATIONAL RESIDENTIAL!kr PRINT CLEARLY NEW:L1 RENOVATION: REPLACEMENT: I._ .1 PLANS SUBMITTED: YES Li NOLs,_A APPLIANCES 1 FLOORS BSM 1 2 Ell 4 © 6 7 8 9 10 11 12 ini 14 BOILER i __ _ .-.-_ .._.___. BOOSTER _ __^- ��� �� i f i # i� E. ' . : E II CONVERSION BURNER ilikiiii_iiiiiitinniiiiiiiMiiiiiiMaiiiiiiMilik=-. COOK STOVE i E` Isammeam DIRECT VENT HEATER 110011111MNIMINIMMOMMINXIMI11.01111111111111111111111110111 DRYER 4.__A> s FIREPLACE _ i . -{{ i i F L. FRYOLATOR I." ,.1 ` l FURNACE ' 11 ';_. :- . .MN ._1:1I WM.'1_:-_-__1_1.:_:.-:.1_ie 1 GENERATOR ai : _ r w .. _ .�.. I0 _ 1,J/L0.`1I1,1-.1—.I..L.7:17._„..1-, INFRARED HEATER i, � � � ! I �[ t � 1 LABORATORY COCKS ' -� ' . xM,l.- ^I i i it I MAKEUP AIR UNIT I _i ' ,_ [ �. I r-,I • � ir-M � OVEN ,. -, - I �I °if ~ E � POOL HEATER 1 1, -t i. ROOM / SPACE HEATER l 1 I r i I I , ‘; I _- {; -�'"- ROOF TOP UNIT -. — -__ -_- ! ! •; TEST -------I _,� I `� °! f i� UNIT HEATER __________c_____,r_____ ._ . _....1._____i _______r______,r____. 2 r _____1_,.._.,7 _I r::::_. i:_ _____I, : 317.77, 4, .4.4,„ 44.,.6.,......, ,...... w.A. •A L. •n,,e,_,.... 6 / I i ,„,,,,, I„....,. z .I UNVENTED ROOM HEATER I� I — I I7 1 _ } WATER HEATER _--- _ * . _:_. ___' � t liit OTHER _.._ mm��. °� I• r ..___ _.,..1_, ..*:.i: ____.. ii:._ _._1.--n t...„_-1.. _ „..,.c._._[..---,_,,ti—_.J, _ -1-- —1 1--1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MCI_ Ch. 142 YES l,iI0 Ei I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY LI BOND Li 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 [J AGENT [ 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 compi;ance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t --4._ 64-- PLUMBER-GASFITTER NAME /'-i-r1 , \ _____Lan_,..„.„,,^,..1 LICENSE #[;- . t SIGNATURE MP Fl MGF L: i JP 2/JGF E LPG! EI CORPORATION [ # � j PARTNERSHIPH# 1 LLC L .__- ,_- ____ E COMPANY NAME: . _ ,0 2 twribi t :471-j_LL fi ODRESS Lei-fr-- , 147:1:CfeD 0thizj- Ij CITY1Vl'rl'�'�%� '� STATE ZIP - i $ -'t4---- Lt%L ],..... FAX L.... ._.____.j CELL EMAIL L/\,,,A_,,,,,..!„.),1C,<, I it t- -100 . �v..•.....,.t'. - yamIn::y.`� ,.. .......-.......„y._.e...-...,,e^........ ......... .. .._...... i -VA (flog