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Home My WebLink AboutBLDG-22-004784 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 28,2022 PERMIT# BLDG-22-004784 II JOBSITE ADDRESS 117 FREEBOARD LN OWNER'S NAME Justine Podurgiel G OWNER ADDRESS 117 FREEBOARD LN YARMOUTH PORT MA 02675-2070 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER WATER ROOM HEATER 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❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have theinsurance 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 IMark Chalker I LICENSE# 32313 SIGNATURE MP❑MGF❑JP El JGF❑ LPGt❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: MARK R CHALKER ADDRESS. 483 COUNTY RD,PO BOX 43 CITY (MONUMENT BEACH I STATE rMA ZIP 025530043 TEL FAX CELL EMAIL IchalkertuelCScomcast.net S31ON M31A32I NVld #iWWd3d $:33d ❑ ❑ .IV d 3H1 SV S3A J S NOI1V3llddV SIHJ ON seA S31ON NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 210d 30Vd SIHI S310N NO1103dSNI WO HOf1021 ��—, ,.-� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -- a, CfTY YQrt'mQt,(�I-(n �;Wts'�' MA DATE 2 L$!Z2 Z_ 1 PERMIT t �1 l�'h JOBSITE ADDRESS 111 Fce¢bOgc-� kh r qq ,,7J OWNER'S NAMEJL( Y?sk. (2., G OWNER ADDRESS Sg'me. TEL TYPE OR FAX PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW D RENOVATION: 0 REPLACEMENT:Ar PLANS SUBMITTED: YES ❑ NO 0 APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 BOILER l 9 10 11 12 13 1� BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER --"'— FIREPLACE FRYOLATOR - FURNACE GENERATOR GRILLE • �— INFRARED HEATER I LABORATORY COCKS MAKEUP AIR UNIT . OVEN b POOL HEATER • p ROOM/SPACE HEATER ROOF TOP UNIT i _ I ' FEI4 2 8 2022� .Z TEST _ ,A. UNIT HEATER .13 ILfittvv ut F- --- Vl LJNVEIJTED ROOF! HEATER • F; HNrrn =Nr "1 WATER HEATER OTHER _ �-- 8 - GE 4 I have a current liaINSUANCEbili insurance policy or its substantial equivalent whicDhvmeets the requirements of MGL.Ch.142 YES IVPEO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY js 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 Massa sett• G n I aw•,and that my signature on this permit application waives this requirement. SIG TURF OF OWNER OR AGENT CHECK ONE ONLY: OWNER,, AGENT 0 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 co nce 't ine ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Lib PLUMBER-GASFITTER NAME N`qci. Chq tt,Cer LICENSE# 325 fi 3 ATURE MP ❑ MGF❑ �/JJP Z JGF ❑ LPGI ❑ CORPORATION ID# PARTNERSHIP 0# LLC 0# COMPANY NAME I" IQrLK CtcL�,�[,�- ADDRESS 4$5 Cothr\`1-y CITY 1"1O V1 tkA ev14' C-IA n STATE MA ZIP 02.--S.53 TEL FAX CELL$ "33-1 017.- EMAIL ROUGH GAS INSPECTION NOSE,, THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT I I FEE: ' PERMIT ft PLAN REVIEW NOTES