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Home My WebLink AboutBLDG-21-006374 ,� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 6 CITY YARMOUTH MA DATE IMay04,2021 (PERMIT# BLDG-21-006374 I '' JOBSITE ADDRESS 188 BARNACLE RD I OWNER'S NAME claudio simoes G OWNER ADDRESS 88 BARNACLE RD YARMOUTH PORT MA 02675-2016 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 Joselin Sanchez LICENSE# 31804 SIGNATURE MP❑MGF 0 JP© JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: JOSELIN C SANCHEZ ADDRESS. 108 BAYVIEW ST, CITY WEST YARMOUTH STATE MA ZIP 026738211 TEL FAX CELL EMAIL giovannisanchez5240yahoo.com 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: \4c m ot1 h iL4 MA. DATE: . z PERMIT# JOBSITE ADDRESS:gP 3.)-\R[1G( I..> OW ER'6 NAME ( ✓�/9D �J,''/-2(2 G:S GOWNER ADDRESSi_�1in aS Ti(/ 4l o(Lf TEL: FAX: / TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL iSi PRINT CLEARLY NEW;❑ RENOVATION:❑ REPLACEMENT:ts PLANS SUBMITTED: YES►'1 NO❑ APPLIANCES-1 FLOOR Bsmt 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 ltA INFRARED HEATER ejila LABORATORY COCK cMAKEUP AIR UNIT 4 OVEN POOL HEATER ROOM/SPACE HEATER , .I ROOF TOP UNIT fi TEST Z UNIT HEATER _ ryt UNVENTED ROOM HEATER , WATER HEATER i ' INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES si NO ❑ If you have checked Yam,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 341 OTHER TYPE INDEMNITY 0 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 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 In comp ante with ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �PLUMBERfGASfITER NAME: '5(L2 r\ L a nC�( ? LICENSE#�'�,/er , SIGNATURE: � —COMPANY NAME: ') '7, ( /i-)-) •-) 1 ADDRESS: /1/A't CITY i///4/1-/ �lf�/n t O c> 11 STATE: /) / '' ZIP. c -1'7' FAX TEL: >4 J40' 6? CELL: EMAItr17AOlo ,,.1� n'Jq.L- Cb;t/1 r / ' MASTER 0 JOURNEYMAN I.; LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑'# LLC❑# C m/9`/C. ADD2•e-5S : C/ �ir,'1 m 771 j ,/ !4, .-a C,'- / 1. oEl • 1-1 • • O ft Z � a CC W d • rr,, •q • ►mot . J a LU W L.. 0 o .