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HomeMy WebLinkAboutBLDG-23-000260 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK lk,,, — s BLDG 23 000260 CITY YARMOUTH MA DATE July 15,2022 PERMIT# Il— JOBSITE ADDRESS 50 TROWBRIDGE PATH OWNER'S NAME Jason clark G OWNER ADDRESS 50 TROWBRIDGE PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO ❑ 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 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Dennis Gagne LICENSE# 9804 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# ] COMPANY NAME: DENNIS M GAGNE ADDRESS. 31 Cherrywood Ln, ] CITY Marstons Mills STATE MA ZIP 026481761 TEL ] FAX CELL EMAIL gagnedmg51 a(�,aol.com 1 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R1.-1-7i',- -- -: i yi-g-4-41- 4d/Ylasef Ill ^ E MA DATE' -/ Z,'Z (PERMIT# I 15 nrITE ADDRESS�� T�Qe,✓�I'7a €�`perM OWNER'S NAME rasa,4 ehr./k 1 OWNERADD RESS ST .G .__..._ I TEL ,FAX' FNAFZI MENT - -RC( UPANCYTYPE COMMERCIAL;r( EDUCATIONAL __I RESIDENTIAL CLEARLY NEW:,J RENOVATION:_1 REPLACEMENT: PLANS SUBMITTED: YES D NO APPLIANCES Z FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER J�J_ J_J_J'—j•_J—!____i,—1_,J J,_J_j J BOOSTER J.—J- (; I 1 —j J_J—J._J • •I' • t—1 CONVERSION BURNER __:---1._(,___.1 I 1 !_}_1:_}_J:—J_1'_1!_.1_I COOK STOVE --J I_-____A'—j- ._±iL -!- :__ J .—J _- -1 ] DIRECT VENT HEATER ._1, 1. _ _J. 1._j ( __I—J i; _J( (:__J_J_: j_J DRYER. :—J J'-1—J�: -_ I I 1 .- --I i._-1—I—J FIREPLACE ,--I—I.—J t, I-J—J u t_`1---.3-_�—1—I__I FRYOLATOR - -- i - .._1:J f: I_-1•._J. .-_.1._.-1_—_I___ I_j_I 14) FURNACE .—J__J J - • I J !.� — —1 - .I i — -__J . - 1-. 1 I GENERATOR J I—!__I I—1___1J�;J I—I! 1 GRILLE �1 1.--1_1--.1—1 iI - I_1_J ._1—I__.1____.1___ I +j INFRARED HEATER _ —J _J _— J!_-- : . I J'—_1—J; 1 _1—J'_— ___j I—J LABORATORY COCKS I^J j !—I--_---1____J, I_ __— _I—._J J _1___ —__1I it MAKEUP AIR UNIT ----, ,, -— I J — _-_-_-I __I—I—I —1 _�j__ . -_.__I,—j.__.J __ OVEN __.I_J i I _._ _1—.1. I ___J—I._J _i__-1_ .. l k POOL HEATER _J___I,__,_J I�J____J• —1._J_J,_.1,__1_J—_J___J I _--ROOM!SPACE HEATER - I 1 I I I I. I_ I I I I I I. I I ROOF TOP UNIT . ;—J , I i J i__J - ' I i- I- . I TEST A✓1G14`'✓ ALI___J I '_ ____,I_____I._i I__ J s r I UNIT HEATER ___-__I I_f_ I 1_._J�_I.__-J J i __._-J:—J�i UNVENTED ROOM HEATER • _-__1—J I i ____.1,---1,—I I__1__ ___ ______ I 1 I—J WATER HEATER. . ------ --- - —J . .. . f — IJ---J!.�1_J_ 1,J • I I= I I OTHER I_1 I 1 _-J I' I —J __I i --I-J._J . I I I I . I_.J.__J i _l __—_I ;_—J-J _—__J_!...___J—_J'___J ._( e._..__ 1__J.__J__.._..I __J �. 1_ I_,J—_1__I__J_-1—I—J I . I. h I _ ,I Ii ILL] 1. i I I , I. _, i 1 •,.... . I t INSURANCE COVERAGE ZI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES la10 J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY :11 BOND LJ 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 ?_I AGENT _J• 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. i.e % k '71-g PLUMBER-GASFITTER NAME /)/'I/ S 177.I//ac/7.-Q -�I LICENSE#q '�/ I SIGNATUR MP i MGF J JP J JGF LPGI J. CORPORATION 75 7 I PARTNERSHIP.T.!.# LLC J#;7 _. f COMPANY NAME: J//zo•/4 I g��l cl. I ADDRESS; /� "-.9C,rj1%' / CITY I STATE?hi I ZIP:~D `/ i TEI -,74/ N-77G'-ely I. FAX I CELL - 'EMAIL': -6/�-e/-/!1(� S�/L.a.'Y •("6.**- 1 I 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 'ale i I