The URL can be used to link to this page

Home My WebLink AboutBLDG-21-004307 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _'� CITY YARMOUTH MA DATE January 30,2021 PERMIT# BLDG-21-004307 Ill € Ir - ` JOBSITE ADDRESS 78 HERITAGE DR OWNER'S NAME ARDITO CHARLES J TR G OWNER ADDRESS ARDITO FAMILY TRUST 78 HERITAGE DR 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 1 DIRECT VENT HEATER DRYER 1 , FIREPLACE 2 FRYOLATOR FURNACE 1 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 1 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 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 Steven Traill LICENSE# 21392 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEVEN J TRAILL ADDRESS. 178 MALDEN ST, CITY MALDEN STATE MA ZIP 021486519 TEL FAX CELL EMAIL 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 • -'-'_ I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK F=75-7��, / = 9 / .�Clf: 2 I CLI 367 -y . R� C(T`( / pC,/ 7 I��, DATE PERIViIT )` JOBSITE ,ADDRESS 7( ��1 C7� P/2 ' OWNER'S NAME nj 4.)y/1h y GOWNER ADDRESSA2 D , C• AG EL (�/7--(C7o9 1;'F.�3 FAX _ TYPE OCCUPANCY TYPE COMMERCIAL EDUCATIONAL I— RESIDENTIAL RI RESIDENTIAL F PRINT _ CLEARLY NEW: n RENOVATION: V REPLACEMENT: ❑ PLANS SUBMITTED: YES El NO ❑ . APPLIANCES 1 FLOORS--4 SSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE _ I DIRECT VENT HEATER I iI DRYER 1 • 1 FIREPLACE .4 i FRYOLATOR I FURNACE -7 7-7:- GENERATOR GRILLE 1 INFRARED HEATER i i LABORATORY COCKS MAKEUP AIR UNIT i OVEN POOL HEATER ROOM ; SPACE HEATER �....... w,,. i ROOF TOP UNIT ' .. t , TEST .. . .. _. .._. . . -._ __ - Y w ... , : : \ UNIT HEATER UNVENTED ROOM HEATER if iNATER HEATER OTHER ._ ..-L A -,ti ,�+ ( j INSURANCE COVERAGE �/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL. Ch. 142 YES l� O ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND I-1 I • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the i Massachusetts General Laws, and that my signature on this permit application valves this requirement. CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT 7.1:: I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur to 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 wits- II ertinent pro ' ' " le Massachusetts State Plumbing Code and Chapter .142 of the General Laws. Il PLUMBER-GASFITTER NAME c�'le-4 eA )ill ' /1 LICENSE # &1..3 90._ SIGNATURE MP ❑ MGF ❑ JP JGF Jl LPGI U CORPORATION ❑ f PARTNERSHIP ❑ # LLC ❑ #1: I COMPANY NAME ADDRESS / 7 i'llg/.4. `5- CITY /17aCIF l�i 17 A0/�'STATE ZIP 02/ �/ TEL 7f/- e `�- 7r/ G FAX. y CELL EMAIL .�, Via i it lo 9 QA..) / je od A eA4, bu1)) ROUGH GAS INSPECTION NOTES Tills PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: 4 PERMIT It PLAN REVIEW NOTES uci Ord Ur«!( grcol % gc) , . • S16 17z 47001 ICL, 7�F 6 SG Arcjre„'Py 711 J O 3 •