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HomeMy WebLinkAboutBLDG-22-006274 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE (May 02,2022 I PERMIT# BLDG-22-006274 JOBSITE ADDRESS 20 KATES PATH VILLAGE OWNERS NAME Dennis Adams G OWNER ADDRESS 20 KATES PATH VILLAGE YARMOUTH PORT MA 02675 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS—s BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 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 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 wit be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Vincent Marino LICENSE# 15136 SIGNATURE MP©MGF❑JP 0 JGF❑ LPG( ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd, CITY (Spencer I STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL permitsabestvetinstallations.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK )1 2 7_ CITY yr) 1004-1 . MA DATE' !--f 1 c)01 c;,7„Ri PERMIT # — ..,,, JOBSITE ADDRESS , t),._,..y,,_ ceotts_.:FcrAinIOWNER'S NAME lYtillo‘ _ V.0c,yy‘S GOWNER ADDRESS - ) TYPE OR OCCUPANCY TYPE COMMERCIALE- EDUCATIONAL RESIDENTIAL II PRINT CLEARLY NEW: RENOVATION: 7., REPLACEMENT: b_t_i PLANS SUBMITTED: YES ! I NOV APPLIANCES 1 FLOORS—* BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER , __,..........„ BOOSTER ,. _ _ CONVERSION BURNER , COOK STOVE DIRECT VENT HEATER ___ ------ DRYER FIREPLACE _ _ _ — FRYOLATOR FURNACE ! , _: . _ _ GENERATOR I , . . , . ----,-, — GRILLE IIH , -- , INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT __---. OVEN 16- _. 1 _ POOL HEATER ROOM / SPACE HEATER .r..... , ROOF TOP UNIT - - — __. TEST ..__ . UNIT HEATER , UNVENTED ROOM HEATER _ — WATER HEATER .-. . ' OTHER - _ _ „. _. ___ _ _ _ i._.. ,--.1 .-_, a- INSURANCE COVERAGE -- " I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES A NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 17.\.(1 OTHER TYPE INDEMNITY I j BOND .----1) .......- 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 compliance with all ert-nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /) c 1 p. r - PLUMBER-GASFITTER NAME Al ‘‘,(\ce_tft\-- 1:7\a\trtno LICENSE # 191 .30 ! SIGNATURE -- MP v_ _I MGF L.j JP 1 JGF El LPGI D CORPORATION ,/# 71-1- -. -- 3 c i PARTNERSHIP 1 _ #: i LLC 17_11#' COMPANY NAME: 03-1-- ytt -_n52-citIct40/1,5 .. -06. ADDRESS \,r. ) i )--ke CeCk0 ---.'" I • b CITY i _3eryce.r STATE k.,:i.' .6 .ZIP (12 -TEL FAXvycs.a5M CELL EMAIL Te(w_ii+S ei b-e,57+ e±in SA-CA 11 4+11)V15 , COO() _ ._ , _ _ _ _ . _ _