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HomeMy WebLinkAboutBLDG-23-005624 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r , CITY YARMOUTH MA DATE April 10,2023 PERMIT# BLDG 23 005624 2 t, JOBSITE ADDRESS 39 MAUSHOPS PATH OWNER'S NAME ODOARDI MARY A G OWNER ADDRESS 39 MAUSHOPS PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 111 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 1 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 Dean Tupper LICENSE# 19002 SIGNATURE MP❑ MGF 0 JP❑ JGF❑ LPG! El CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: DEAN A TUPPER ADDRESS. 50 CENTRAL ST, CITY SOUTH EASTON STATE MA ZIP 023751039 TEL FAX CELL EMAIL dean64(@,comcast.net 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - Z_3-o0S.6.gY .=; l_ _..GTY MA. DATE b---/01.3 PERMIT# • [AP"--10 2 I nBS TE DDRESS I 31_ M ti ,,,s p c Zh OWNER'S NAME 1"\.z1 l .mow,.,1__ _ ' OWNJ R 'DDRESS: _• TEL: _CC . Z—1 1 -C:.g -. BUI.0IN DEPA••TMENT ay _it APE-OR =t= ,. CY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL g 1 T CLEARLY NEW: cg. RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO d] FIXUTRES 7 FLOOR-, Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14-- BOILER _ BOOSTER CONVERSION BURNER _ COOK STOVE t _ _ DIRECT VENT HEATER DRYER FIREPLACE _ FRYOLATOR FURNACE , GENERATOR X _ , GRILLE _ LABORATORY COCKS _ MAKEUP AIR UNIT OVEN _ _ POOL HEATER • , ROOM/SPACE HEATER , ROOF TOP UNIT ' _ _ TEST '54 UNIT HEATER _ . UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabilii insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY p 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 ❑ SIGNATURE OF OWNER OR AGENT 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 i xcompliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ( �3 __i� PLUMBERJGASFITTER NAME: �c'_4.‘ _ ,?tNr.� J LICENSE# 1�t_d 45—Z. 1 Signature COMPANY NAME: r:.E.i ^S .rh t___?�-t.Lj,,,i '. ADDRESS: ..5-0 l �r-'i'4_k $T _. __ - CITY: . ..5,,•. P", .57,F, _. ' STATE: yn ZIP: 0-1.. 7 ? _.__..1 FAX: ..._. TEL: 5 L' L-,1 ti 50 2.2_ _CJ LL:_ 'EMAIL: Cc., L' `l4_?._Cvr.N S.r•_n-Cf MASTER 0 JOURNEYMAN LP INSTALLER❑ CORPORATION ❑# _ _ PARTNERSHIP❑# . LLC 0# ___.__,_T r Town of Weymouth, Massachusetts Robert L.Hedlund Mayor susses . 'I h: �� h MouiN" ZONING - BUILDING - ELECTRICAL - PLUMBING & GAS - LICENSING - WEIGHTS & MEASURES PROGRESS INSPECTIONS FINAL INSPECTIONS SKETCHES FEE $ NUMBER # APPLICATION FOR PERMIT TO 1)0 GAS FITTING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER PERMIT GRANTED DATE PLUMBING &GAS FITTING INSPECTOR