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Home My WebLink AboutBLDG-21-001726 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK l CITY YARMOUTH MA DATE ,October 05,2020 PERMIT# BLDG-21-001726 JOBSITE ADDRESS 28 PLEASANT ST OWNER'S NAME THOMAS J ROCHE REALTY INC G OWNER ADDRESS 28A PLEASANT ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 Keith Farnham LICENSE# 11601 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# _I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: SOUTH SHORE HEATING&COOLING ADDRESS. 57 White's Path, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL info a(�southshoreheatingcoolinq.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 . TA . (-) ......,. . .1).r..-\. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY yarmouth MA DATE[9/16/2020 _ PERMIT # ELOGA—ON i JOBSITE ADDRESS 28 pleasant St __I OWNER'S NAME Thomas roche Y __ __ OWNER ADDRESS TEL 5082477913 FAX .. ,._."",,.......YEN„..,K'l':f'Yty,,,„(...„ :64,(1.4'VaLif.:4(4.(4iif4((rt,,Z.!'f41..!((L(.i.444•Cil 4<Ai(4YP:'44.6•V(:'aali fifidaff'(f(f.r •.-,,,••••.••••,••,•••.•••••••••,••,•,•,,•. TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL r7 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES Li NO 0 APPLIANCES -1 FLOORS-i BSM 1 2 -----3-1 4 5 6 7 8 9 10 11 12 13 14 " � BOILER x -- - I� L) _ BOOSTER _ L I J i CONVERSION BURNER if l if 11.11f if li l COOK STOVE 11111111111111111.01M0111101111110110111100111 1111011111110111111111111111111100111 DIRECT VENT HEATER I IIINII IMIRIOIIIIIWMI II I ITI I DRYER IMO IIIII MON101100(10. •101 010 I1M FIREPLACE tI1Ii NM FRYOLATOR .. _.. . :IOIIIIIIOIIMIIISIIOIIIIIIIOIIOLIIIIIIIIIIIOIIIII FURNACE ��I __If 11E l��1I lf�lLl1.111 GENERATOR ------ -v(4fffK_ ,��I'� � 1 GRILLE111111.C.---1 . IIIMIIITMIIIIIIIIOIOMIIIIMFMRIIM INFRARED HEATER .r"'-11.11111111MMIONAM LABORATORY COCKS .,�v�,,,, . 1�� W"I MAKEUP AIR UNIT .._ --- _..—' — 011.1-M1111.111.01.. OVEN IMIOOI if l 1F . tI:�1 IMIIIF IIO I POOL HEATER r11101m10011.1111001WIMMIIIIIONO ROOM / SPACE HEATER MINIM . ROOF TOP UNIT �� 1��W�M TEST mom mL. mo im Ilm UNIT HEATER �:�.. : 1� ,1I �; ,� I��1 UNVENTED ROOM HEATER E� ( IIiIM1i1, IIIII(I1 WATER HEATER ___.._._._. ._ . 1111111111101111111111111011101111011111001110011110001.sommiaimmamo OTHEFL----__ _-.._-.__...._ . immomainumiiiimmoisamosisisminiaiiimuseimmi ....1 ,„..,,„,,„„,,YY ,„,,'IL"'=Y'Y'•T«"'•'Y""""YY""',"". 11111111111111•11111111�• •'I 1110 IL1I '.III_ ._I. .. f I 111.710110110. ____ _w ....... w... 1 �_�lll� ��1I�1IJ ._�,.._. ___. ..••• --_.._..1.'w.r...___. _____._w ',Argo.___ . .. ___ _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 7 NO [. I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 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 complia e wit al Pe -provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' PLUMBER-GASFITTER NAME Keith J. Farnham LICENSE #1 11601 GNATURE MP i MGF JP ' 1 JGF LPGI CORPORATION 7# 3698C PARTNERSHIPLJ# _I LLC # 4 COMPANY NAME: South Shore Heating & Cooling a ADDRESS 57 White's Path ------- . .____J CITY South Yarmouth ----� - -rmu STA .�_ ....] - - . TE MA ZIPr..._____ 2664 TEL � 508 398 6901 j FAX 508-760-2681 ; CELL EMAIL info asouthshoreheatin 2 ; i