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Home My WebLink AboutBLDG-21-006586 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTHk, MA DATE May 13,2021 PERMIT# BLDG 21-006586 ` " JOBSITE ADDRESS 65 NEARMEADOWS RD OWNER'S NAME KELLEY STEPHEN S G OWNER ADDRESS KELLEY ANNA S 225 SOUTH VERMILLION AVE BROWNSVILLE TX 78521 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO El 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 UNVENTED ROOM HEATER WATER HEATER OTHER 1 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY❑ BOND El 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 Barry Gremila LICENSE# 10244 SIGNATURE MP El MGF El JP El JGF El LPG! El CORPORATION El# PARTNERSHIP El# Lc El# COMPANY NAME: BARRY R GREMILA ADDRESS. PO BOX 1025, CITY NORTH EASTHAM STATE MA ZIP 026511025 TEL FAX CELL 5082373878 EMAIL none t 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 CITY , - ^vt-t MA DATE r —-- r �. .w. _ j.. PERMIT # I JOBSITE ADDRESS 51.4!ect,r »tits. OWNER'S NAME L.51:_r_w), rn,_,„. 1--,-,:- /i k.e_-.7 , GOWNER ADDRESS __ _____ _ _____ __ --- - -1F TYPE OR +f OCCUPANCY TYPE COMMERCIAL. EDUCATIONAL , RESID �,:r PRINT ENTIA4 CLEARLY NEW: ,..._ RENOVATION: . , REPLACEMENT: U PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-+ BSM ni 2 3 4 5 6 7 8 9 10 ` 11 12 13 1 14 BOILER MIIIIIMIllitillicini BOOSTER F J : 1 1__L _ i i _ CONVERSION BURNER - ,- , �' # C ._ N .__ _ ice,.-Mai --- : §_ M.COOK STOVE l 'a z 111.'` 1.1Y DIRECT VENT HEATER _ — Millinfiiillr I1 1. ' DRYER �.__. MINK - - 1 �� TI _ - IJ FIREPLACEE � l' � { _ _ s FRYOLATOR11�, ... .. _ ii FURNACE �-- = GENERATOR MAN__ --------- -- . - -. _ ..____ GRILLE at j - m� INFRARED HEATER °`- -,Ms j LABORATORY COCKS ,_ 1 __ _ = _ i �' _l— ._. 'i MAKEUP AIR UNIT - -- - 1 - OVE N - -�---Amer ' - --- POOL HEATER I Kall ROOM/ SPACE HEATER ROOF TOP UNIT � ';� i _.. - -- _.�_ _ .,� TEST ---- _ _ --- - = —_ - �.. _ s — - UNIT HEATER =IIMM 1 ITINk IMEnM I-I..- 3 UNVENTED ROOM HEATER -- __..,�r�..�_.._ ., r.._.=- , ----' i,i iInIIII: _ w MIaIIMn_ 1i)11n111i1p1.1g__1_.WW__1__Iin N1.I1M1i o1 11.,1,,I WATER HEATER " - OTHER i iI -- - Ilinliiiiiilir -� � f ,, mit. _ ',. _.. .._,._____ • INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES !x NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY it 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 Massachusetts General Laws, and that mysignature on this g permit application waives this requirement, CHECK ONE ONLY: OWNER 1 i 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—1 and that all plumbing work and installations performed under the permit issued for this application will be in complian e 'th all Pe ' t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME :, - G V'`�►� `� LICENSE #r UZ. y SIGNATURE MP MGF 1 JP JGF LI7 LPGI CORPORATION 71# PARTNERSHIP. -#- _ -,v LLC # COMPANY NAME' -c 4L 1€ V` JADDRESS_ 3 .- (025- �_ --CITY _ �. L 4;� ' r u STATE I �_ _ T_ f r t �iZ P _: FAX CELL IEMAILL