Loading...
HomeMy WebLinkAboutBLDG-21-006832 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 VII CITY YARMOUTH MA DATE May 24,2021 PERMIT# BLDG-21-006832 JOBSITE ADDRESS 86 Old Hyannis Road,Yarmouth Port,M OWNER'S NAME RUHAN GENERAL CONTRACTING,LLC G OWNER ADDRESS 86 OLD HYANNIS ROAD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:0 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 1 DIRECT VENT HEATER DRYER 1 FIREPLACE 1 FRYOLATOR FURNACE 1 1 GENERATOR GRILLE 1 _ INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER _ UNVENTED ROOM HEATER WATER HEATER 1 ( I 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 0 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 Daniel Messier LICENSE# 15640 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# _ PARTNERSHIP ❑# LLC ❑# COMPANY NAME: DANIEL C MESSIER ADDRESS. 237 ELM ST, CITY N ATTLEBORO STATE MA ZIP 027603223 TEL FAX CELL EMAIL danmessierplumbinqayahoo.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 "ail 1: .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4*f €,- CITY: Qr 1/•00( . ; � y MA. DATE: PERMIT# JOBSITE ADDRESS: 86 014 I ),{11 vi/S (-zzi OWNER'S NAME: G OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRLNT CLEARLY NEW: RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-1 FLOOR--I, Bsmt 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 I • FRYOLATOR FURNACE I - / GENERATOR / GRILLE VI INFRARED HEATER LABORATORY COCK _ . MAKEUP AIR UNIT OVEN ,' POOL HEATER ROOM/SPACE HEATER -.I ROOF TOP UNIT $ TEST _ UNIT HEATER ill UNVENTED ROOM HEATER WATER HEATER 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE 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. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT 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 compilanca,with ail Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. PLUMBERIGASFITT,E\R NAME: )C`\ r 7L�" LICENSE# I`�6` 0 SIGNATURE COMPANY NAME: JCl1fL S S(Jv1 0 f H _U (, ADDRESS: d,3 7 E vil 51. CITY: A) A l -1-1 -Z vt STATE:AA ZIP:0C /6() FAX: TEL 771 a. 76 d Li CELL: < £ VI'LQ— EMAIL: C14 (,t AIL $c.o.pi L ri I)rl-I� ') yC ow.CC^'� 2r MASTER❑ JOURNEYMAN❑ LP INSTALLER El CORPORATION # O g PARTNERSHIP 0# LLC 0# c h9 4-/L d9DZkz Ss : ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE S PERMIT I PLAN REVIEW NOTES