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Home My WebLink AboutBLDG-23-000223 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kgsk CITY YARMOUTH MA DATE July 13,2022 _ PERMIT# BLDG-23-000223 JOBSITE ADDRESS 23 BRADDOCK ST OWNER'S NAME GOGGINS KENNETH W G OWNER ADDRESS GOGGINS MADELINE J 236 WESTMONT DR WATERBURY CT 06708-2436 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 ❑ NO❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 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 'Michael Mcbride I LICENSE# 19681 SIGNATURE MP❑MGF❑JP El JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'MICHAEL R MCBRIDE 'ADDRESS. 19 Rustic Drive, CITY 'West Yarmouth 'STATE MA ZIP 02673 TEL ' FAX CELL EMAIL 'stincier.mcbrideltyamail.com S310N M31A32i NVld #IIIN2ind $:333 ❑ ❑ 1I01213d 3H1 SY S3A2i3S NOI1d3llda SIH1 oN saA S310N NO1103dSNI 1VNId AINO 3Sfl e10103dSNI Hod 30Vd SIH1 S310N NOI103dSNI SVO HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A P - RM[T TO PERFORM GAS FITTING WORK 1.1EMS,Fe �1 - .,5 CITY MA DATE F 2 3 -- P._f�t(UIIT , o Z Z 3 ~ JGBSITE ADDRESS 2,3 , 4ci. t. 5 OWNER'S NAME GOWNER ADDRESS Los TEL3Zre - 2_y 1/ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: N.. p I pe PLANS SUBMITTED: YES ❑ NO141' APPLIANCES FLOORS—I BSIv1 1 2 3 1 5 6 7 o :, 9 10 11 12 'I 3 14 BOILER , BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER, FIREPLACE FRYOLATOR ' FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT R E C 1 OVEN .. �_. POOL HEATER ' ROOM ! SPACE HEATER LI - 1 ROOF TOP UNIT TEST _ . . ..- . ., . . . . .- .. . . - .._. . .. LIBRY"--44----111N—G _a�NAR I MAN I�UNIT HEATER —------� — — I i INVENTED ROOM HEATER 1---- _ I I WATER HEATER I I OTHER I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL. Ch. 142 YES C NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 5_ OTHER TYPE INDEMNITY ❑ BONDS ❑ 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. �` SIGNATURE OF OWNERCHECK ONE ONLY: OWNER ❑ AGENT ❑ OR '.!:: 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 Getter Laws. ft '� i --( . .\.___) PLUMBER-GASFITTER NAMEpk GV`�te d '`vA r LICENSE # (, /L-- LICCIJSElot Iv�l SIGNATURE MP E MGF ❑ JP 0 JGF ID PGI CORPORATION 0 # P r0 P PARTNERSHIP ❑ It LLC ❑ COMPANY NAME NACZ r iak ± A { S ADDRESS 7 I—r cirl Li l ✓1 Are CITY \ n� S STATE 1.11tki\- ZIP 6 2(06 I TEL_ 7Yrdc,i ?/ 7 `-( FAX CELL EMAIL f' .vkiW L- '-Ow.. ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES S Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT et PLAN REVIEW NOTES