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HomeMy WebLinkAboutBLDG-23-000112 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE July 07,2022 _I PERMIT# BLDG-23-000112 I JOBSITE ADDRESS 20 FESSENDEN ST OWNERS NAME LAPOINT JOHN J G OWNER ADDRESS LAPOINT LILLIAN M 20 FESSENDEN STREET SOUTH YARMOUTH MA 02664-2919 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 ❑ 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 !Wayne Edwards I LICENSE# 131581 I SIGNATURE MP❑MGF❑JP© JGF❑ LPG!❑ CORPORATION❑#I I PARTNERSHIP ❑# LLC❑# COMPANY NAME I I ADDRESS. 126 Bunting Lane, CITY 'West YarmouthSTATE MA ZIP 102673 (TEL I FAX 1 1 CELL 17748362534 1 EMAIL Iwavnetheplumberanamail.com S31ON M3IAMI NVld #LII J3d $:33d ❑ ❑ iI141213d 3H1 SV S3/113S NOIlVOIlddV SIHJ ON seA S31ON NO1103dSNI IVNIH AlNO 3Sf)80103dSNI 2103 30Vd SIH. S310N NO1103dSNI SYO HOflO 1 ' '` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i - x 1i4 Alt° MA DATE 7- 1-u2iZ PERMIT# 23 - cilz R " JOBSfTE, D ESS V65S6N iX/ 31 OWNER'S NAME /LA- POlNTG lL { n414.A DR:SS TEL FAX �iG u ►3�TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[/ NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES APPLIANCES 1 FLOORS BSIv1 1 2 3 -1 5 6 7 U 9 10 11 12 BOILER 13 14 BOOSTER CONVERSION BURNER - ---_I COOK STOVE -y DIRECT VENT HEATER i DRYER FIREPLACE FRY DLATOR FURNACE GENERATOR i - . GRILLE , H �J INFRARED HEATER ' —�7 LABORATORY COCKS • I 1--_H MAKEUP AIR UNIT __1 OVEN POOL HEATER • ROOM I SPAC:E HEATER I — _____I ROOF TOP UNIT j TEST . . . - — i UNIT HEATER • • UNVENTED ROOM HEATER WATER HEATER OTHER L , . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY ❑ BOND ❑ • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the fMassachusetts General Laws,and that my signature on this permit application waives this requirement. . i CHECK ONE ONLY: OWNER ❑ AGENT ❑ •� SIGNATURE OF OWNER OR AGENT -1•• I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe ' nt prov' ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Qt PLUM BER-GASFITTER NAME W/I yil 601162PS LICENSE# 3i S$I SIGNATURE MP ❑ MGF❑ JP 12/ JGF❑ LPGI ❑ CORPORATION❑IF PARTNERSHIP❑# LLC❑ COMPANY NAME kNoliePS PGuwtf3046 2( 0f1,-6 ADDRESS 2 ' gJi,iJ& G- C CITY Jiv6i5 i Yf}KMoui K STATE A ZIP o2473 TEL /T't-836-2-s3L/ FAX CELL EMAIL WAyv&rue Pwafwe(4)Gwt/W.,ez 4 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yez N� THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT ft PLAN REVIEW NOTES