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Home My WebLink AboutBLDP-21-000185 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ‘40- CITY YARMOUTH MA DATE IJuly14,2020 'PERMIT# BLDP-21-000185 JOBSITE ADDRESS 25 VACATION LN OWNER'S NAME MARYANN TREVELONI G OWNER ADDRESS 25 VACATION LANE WEST YARMOUTH 02673 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© 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 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 0 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 ❑ 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 'Michael Mcbride I LICENSE# 19681 SIGNATURE MP 0 MGF 0 JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: 'Michael R Mcbride I ADDRESS. 1 Mayflower Ln, CITY 'South Yarmouth I STATE MA 1 ZIP 026644220 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 ❑ El • FEE: $ PERMIT # PLAN REVIEW NOTES , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK = CITY l de/4 ( MA DATE PERMIT# 3/PC-0/-c /Kr JOBSITE ADDRESS t� G v Q- y t .GUI I OWNS 'S NAME c, Ctfe DLJ,( G --_-- OWNER ADDRESS ; �f TEL �i FAX TYPE OR OCCUPANCY TYPE COMMERCIAL:_) EDUCATIONAL _J RESIDENTIAL I PRINT CLEARLY NEW:,J RENOVATION:.) REPLACEMENTJi PLANS SUBMITTED: YES-1 NOr J APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER __J 1 _1_I____J_____1 I I_J_-_I—! t__-I—J BOOSTER I I I I-J— _J ._._.1___I._J 1 J —J J CONVERSION BURNER i I I I ± I I I ____1_1 i _J COOK STOVE I I +:' _! I__IJJ;J—JJJ I !_! DIRECT VENT HEATER I—J _!—f_J ! _J - I -_ . ..ram 1 I ; DRYER i' I _1 1 __J 1 JAI I ._. 1� j—J FIREPLACE _1 I—1__J I 1 I _ _J i 1_J I I J 1 1 FRYOLATOR J 1 ___I:_ I . .. _ I i 1 1 _ _I 1_._._1 J I FURNACE .__—1 �� I_ I_J l I '_J ' ---_._.1__._.._J ...____I J I GENERATOR I I i i I ! 1 GRILLE -_ - .- -_:_----� I-----,- ___i J__J _-___I I `_--J_._J'__1 _ I __J ..____J i ._._J INFRARED HEATER 1 —J—J _-1._ I i_I 1_I —J __ _1 I--J LABORATORY COCKS ! !._____ 1.__.___I I I . . 1 .____(_ I I--_ II I MAKEUP AIR UNIT I ' I_ I I _I I �_— _—_--- I 1 _ i, I i OVEN 1 !._ i I ''__J __I .I .�"`-i-_ _I' ��'--_._._I ._.1 i POOL HEATER I_I_____J �J I __I J i _L J_.__.-_I I_I I I ROOM/SPACE HEATER I-___I i i .__-! _ 11-!I1_-1-14-- 41,--- _.J ---1 1 ROOF TOP UNIT _._...' __._.. i I_ _.J{_...__J Iy....IU i.1 i r TEST ----.;- ' __I _ 6Uu , ;., I 1 i UNIT HEATER _�1 i _ - _-"y'___ 'C:,rf �.�a-`T` `—'i UNVENTED ROOM HEATER �` N r 1 _.J __J _,__J 1 _____i___ _. ____I -_I ..�1 _.____i —__ WATER HEATER + I I____J I___1____._1____J____J_____1 I _J OTHER ! I — I I_... i__.._I _._._I J ____-_.I _._I___J I 1 _ - 1 i . I 1 I I __ I i I I i I I i.____J _-_J__J Illt INSURANCE COVERAGE ZI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Al NO 1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY+ OTHER TYPE INDEMNITY `J BOND Li 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 ertinent revision of the Massachusetts State Plumbing Cot3JJl and Chapter 142 of the enera Laws. PLUMBER-GASFITTER NAME f�/ ( �44p L I LICENSE# SIGNATURE MP _J MGF JP JGF LI LPGI _J CORPORATION _i# - -I PARTNERSHIP 1# I LLC 1# COMPANY NA ( it 1 a_Q PH4 ADDRESS 972._U (J 1` ( c . jr v`r - I CITYk). i al 1../too/%- -! STATE -1 ZIP I16_-7$iTEL"1?y C /O ( Z FAX I CELL I EMAIL per;-0J` • M C ,j ric(L. o7 Dit 1 1 ` c(J^-. 1 Li 0 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES l— Its•N81.. • SK-t ..+r:' .