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Home My WebLink AboutBLDG-21-006373 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 04,2021 PERMIT# BLDG-21-006373 i—�j k,,, �i sy F JOBSITE ADDRESS 223 ROUTE 6A OWNER'S NAME FITZGERALD SHEILA M TR G OWNER ADDRESS SMF REALTY TRUST 223 ROUTE 6-A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 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 14 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 0 BOND 0 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 Juan Candelario LICENSE# 1292 SIGNATURE MP 0 MGF ❑ JP 0 JGF 0 LPG! ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. 70 Winthrop road, CITY Plymouth STATE MA ZIP 02360 TEL FAX CELL EMAIL none ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No S/e 2/ f/dsss-, THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =-�°�= ° CITY \laC --Y} MA DATE \v1k--4 ac&\ PERMIT # JOBSITE ADDRESS 33,- e , ,i...e P OWNER'S NAME-14-2 Ci1 L��ri tirn Fry I( n J GOWNER ADDRESS TEL FAX TYPE OR OCCUPAN Y TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES -1 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 y.� __... .. DRYER . r — FIREPLACE i MAY C A 2 i FRYOLATOR , L _ FURNACE + - LIM®lN� cry- r4:ArTE��r GENERATOR --_---- ,�- GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN _ POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER /4/ UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO n I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Et/ OTHER TYPE INDEMNITY ❑ BOND [I 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 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 compl. -ce with all P irient provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `- / _____,,... Sh PLUMBER-GASFITTER NAMEC.viC e /4v /6j LICENSE # /()1-02 NATURE MP MGF ❑ JP JGF ❑ LPG' r( CORPORATION ❑ # PARTNERSHIP ❑ # LLC 0 # COMPANY NAME /146 '1 14, ADDRESS /3 t-icl i /v"` R ( CITY ,//// c�'�/7 -vo STATE �/% �r ZIP 0,7234a, TEL �o� SiS-6;5/� FAX CELL EMAIL