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HomeMy WebLinkAboutBLDG-22-004674 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ......._._._ CITY YARMOUTH MA DATE (February 23,2022 I PERMIT# BLDG-22-004674 JOBSITE ADDRESS 747 ROUTE 28 OWNERS NAME MULLEN CHRISTOPHER P SR G OWNER ADDRESS MULLEN TERESA F 38 CHARLES ST ROCHESTER NH 03867 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 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/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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 Francois Paravisini LICENSE# 115211 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑#I ILLC❑# COMPANY NAME FRANCOIS PARAVISINI ADDRESS. PO Box 2585, CITY Orleans STATE MA ZIP 026536585 TEL FAX CELL I- EMAIL bayside(a,thecapecodplumbers.com S3lON M3I/13b NVld 1 #±IWb3d $ :33d ±M141a3d 3H1 SV S3A83S NOI1VOIlddV SIH1 oN seA S31ON NO1103dSNI 1VNIH j AlNO 3Sf1 I0103dSNI 2103 3OVd SIH1 S31ON NO1103dSNI SVO HJf101:1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK milarm _111= CI MA DATE PERMIT # " � C� JOBSITE ADDRESS 7T7 D?S OWNER'S NAME in 0114 OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL. - PRINT CLEARLY NEW: ./ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS-4 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 FIIDnIV,A\ E - I lJi\I 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES v NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY L 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. CHECK ONE ONLY: OWNER f' AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicat'.n are ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will • - '• . p a e with all Perti i ie�a-e .tl�e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Francois Paravisini LICENSE # 15211 ' SIGNATURE MP v MGF JP v JGF LPGI CORPORATION # 4288 PARTNERSHIP # LLC # COMPANY NAME: Snows Fuel Co ADDRESS 18 MAin st CITY Orleans J STATE MA RIP 02653 1TEL 508-255-1090 J FAX ` CELL EMAIL bayside a©thecapecodplumbers.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 1