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Home My WebLink AboutBLDG-22-006136 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK iCITY YARMOUTH MA DATE IApril26,2022 (PERMIT# BLDG-22-006136 JOBSITE ADDRESS 16 ACRES AVE OWNER'S NAME Eric Rosenthal G OWNER ADDRESS 16 ACRES AVE WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES El NO El 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 1 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 1 OTHER DESCRIPTION:fire pit INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El BOND El OWNERS 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 El JP❑ JGF El LPG( El CORPORATION El# PARTNERSHIP El#I ILLC El# COMPANY NAME: DENNIS M GAGNE ADDRESS. 31 Cherrywood Ln, CITY [Marstons Mills STATE MA ZIP 026481761 TEL FAX I I CELL EMAIL gapnepmo5l(Saol.com S31ON M3IA321 NVld #1IV I3d $:33d 1I1^12ed 3H15`d S3A213S NOIlVOIlda SIHl oN seA S310N NOI103dSNI 1YNId AINO 3Sf1 N0103dSNI JOd 3OVd SIH1 S310N NO1103dSNI SVO H0f1021 'i` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 's I_ CITY )7,7'' -ec47/2. [ MA DATE' y -25-2 Z4 PERM- -2-1-- - I /C., JOBSITE ADDRESS / �G t s ] i/ Pi f OWNER'S NAME e., r16., /'v 5 e-��''1 u/ _— G OWNER ADDRESS i -S q L ^---- .- _ _- ,__,.__.-,1 TEC ,FAX ( TYPE OR OCCUPANCY TYPE COMMERCIAL J EDUCATIONAL PRINT j RESIDENTIAL CLEARLY NEW:,-J RENOVATION: REPLACEMENT:J PLANS SUBMITTED: YES,0 NO J APPLIANCES Z FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _1—J_ 1—J— .�!__J— — _, !_f 1 (_____I t _J BOOSTER :—J`I j: I t . I —J—1_J_ t 1_J—J CONVERSION BURNER I__:_J—I—J _ I_I I _J _1_1 _J__I COOK STOVE —J I `_1—_I-__I—J—J:__J_•—f_I J-1.__J—J�___J.,—J DIRECT VENT HEATER ____J-J___I-,___I-__f•—J-.J �.Iti _ -J-1 , DRYER• —1-1—J, __L-1: ___J- -I.- .I ._ I_-1 _. j—J FIREPLACE -I_J_I, I_j. I_I t_J_J I - I_1 FRYOLATOR 1 f_1,-1 t: I_J _I i. 1,_—1,_.i______I 0 FURNACE _1_J,� I J"� I_J —J I 1 --_1 _—I_J IGENERATOR qI_ .. t I__..1 I_-1 I—J_J—J J J___J—J T GRILLE __I -... f-1:�!_J ... I__J—J—I I __J___1 —J—1 INFRARED HEATER —.J —_I'—J—I - -I —I__—I—J*J I —J '_ —_1 LABORATORY COCKS I_1____J____I^1—J . 1 I _..__-._-_._J____J,—J—J__I MAKEUP AIR UNIT , I'JJ__ __._. _ l i I__I____J —J _I__1-___1;_ 1 OVEN _J_.J . I I-1.__J .I I___.J I _._J__i____J__J I POOL HEATER _J.—J_._-_ ,-__I_rJ I____J�J_J_J J___J r-J—___1 ROOM 1 SPACE HEATER 1 . . ..1_.. . .1 . .. .1 _ �J I I_ I I ROOF TOP UNIT __I I r—J ;_J__-1 '. ('J J—J_1_J TEST —I_____1_____) '_ 's I—I_�I—_t 1 i i I I UNIT HEATER I __ J__J_—i ; t—1— "—i• J ___ J - - i —J . j _ I — UNVENTED ROOM HEATER . J_ .J I__J i I - I_._,J__I_j_I____1 _—j__I WATER HEATER. . ------ ---.._.___.I f —J !_-_J--J_J—J . . .r—J--I i OTHER .-____- _..., .-1�J .i I'—J 1 _____ I_1_.__-_1_-1____I_J__i --4+ 5 °_k G' 1 l T( i J 1 i -J _1. .J Li ' -J'.� ,J .-J © 1 e. � , L C`�0 }:. J ci ..r i . I,i 1- -I:J<_-J-I j_!___--I i ',=I--J _J__-1_ -_f"-J I I . } I I i J.J I I I _I I i I INSURANCE COVERAGE CI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E' d0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 OTHER TYPE INDEMNITY _J BOND ill 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 compliarlcel•with all Pert p n of the • Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4-.-w-rsU> ./. ,_ i� PLUMBER-GASFITTER NAME, _;_s--_.. ;�, "--' �`___ LICENSE#'/LPG inn J ill'INATURE /�vn�is /, I L( � SIGNATURE MP MGF;,J JP JGF J LPG!J; CORPORATION lJ#7X 1§ -I PARTNERSHIP !# - LLC 11#^ - 1 COMPANY NAME.J-2//P0i,/s Al;./ e I ADDRESS 1/�1/r>,7 S� . __ -.._._ _._... I STATE` A. . ZIP. v (rl ? TEL -...?C_ . CITY �.1/ Q�'/71d��G"� .. _.. .. . - -- -•- 1 7�� -G��_C FAX I CELL' EMAIL` �/Ge�/ �,5`l�'QUC. �G../ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yea No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES • • %S 41.. ' 'k- C C.