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Home My WebLink AboutBLDG-22-004275 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 01,2022 PERMIT# BLDG-22-004275 JOBSITE ADDRESS 859 WEST YARMOUTH RD OWNER'S NAME Kelly Morin G OWNER ADDRESS 859 WEST YARMOUTH RD YARMOUTH PORT MA 02675 TEL 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 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 1 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 El 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 Chris Poire LICENSE# 33901 SIGNATURE MP❑ MGF ❑ JP El JGF❑ LPGI ❑ CORPORATION El# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 37 Calvin Drive, CITY Dennis STATE Ma ZIP 02638 TEL FAX CELL 7748366461 EMAIL mcplumber(a�gmail.com S310N M31A3a NVId #111V:3d $ 33d 11WH3d 3H1 SV S3A83S NOI1V3IlddV SIH1 oN S8A S310N NO1103dSNI 1VNld AINO 3Sfl N0103dSNI bOd 3OVd SIHI S310N NO1103dSNI SVO HOfOH ,; r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT T `�le t- JVIII PERFORMGASFITTINGWORK R -tk .;��w,5;- MA DATE 2 :), )..._ PERMIT ZZ — �t Z s� JOBSITE ADDRESS es S t.,�; cl. S I �jG i rriciAiL t` ck OWNER'S NAME K /MN" ,t\ GOWNER ADDRESS S TEL '10 t' tie ( 506 FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL [---.....-. • CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: f'-1 PLANS• �--- �'LANS SUBMITTED: YES (] NO ❑ APPLIANCES FLOORS-4 BSIVI 1 ? 3 4 5 6 BOILER o 9 10 II 12 I3 14 BOOSTER CONVERSION BURNER COOK STOVE L f ! DIRECT VENT HEATER DRYER, _ I FIREPLACE --, FRYDLATGR i �'' FURNACE GENERATOR GRILLE :17j INFRARED HEATER LABORATORY COCKS i MAKEUP AIR UNIT OVEN j POOL HEATER • ROOM I SPACE HEATER ROOF TOP UNIT TEST . UNIT HEATER - _ UNVENTED ROOM HEATER - I WATER HEATER OTHER - l INSURANCE COVERAGE I have a current IEabiie insurance policy or its substantial equivalent which meets requirementsthe of �IGL. Ch. 142 YES -��.��o C-j I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF CO\IERAGE BY-CHECRING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND ri OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance corer ` Ma ��r_huse(ts General Law, and that mysignature ature on permit application fie recloir d by Chapter 142of the I. /`� � ' ` � this w�tve,, this requirement. // 9 �� SIGN URE OF OWNER OR AGENT CHECKONE ONLY: OWNER ❑ AGENT ❑ "�:, l hereby certify that all of the details and information I have submitted or enteredthis �; and that all plumbing work and installations performed under the permit issued or this application are true and a rate to the ' ► 1, Massachusetts State Plumbing Code and Chapter 142 of the General Laws. application will be in compl' nce i t all Pertitien ro st �isioY knowledge �� , n of the PLUI��GER-GASFIT'rEP, NAME _..._ �.._ _--- LICENSE 3 / GNATURE �VP ❑ MGF ❑ JP JGF LPG' ❑ CORPORATION ❑ lF PARTNERSHIP R,,5H1 P ❑ it LLC El �:COMPANY NAME 90 IC- @ '� _ �-r`�'� i, �..f i, ADDRESS �. . CITY eti- ' r -)c i1 STATE Y� ZIP _ C-3 ,� '.� �; FAX TEL FA CELL _ .ZLe,_.,3 w �l� EMAIL ROUGH GAS INSPE�TION I IC)TES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES