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Home My WebLink AboutBLDG-21-005422 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11111 (• CITY YARMOUTH MA DATE March 22,2021 PERMIT# BLDG 21-005422 JOBSITE ADDRESS 23 HILLSEA RD OWNER'S NAME TRONGONE JEFFREY M G OWNER ADDRESS TRONGONE PATRICIA 9 ALDER WAY ARMONK NY 10504-1337 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ 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 2 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _ROOM I SPACE HEATER ROOF TOP UNIT TEST 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 El BOND El 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 Keith Farnham LICENSE# 11601 SIGNATURE MP El MGF ❑ JP El JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP El# Lc El# COMPANY NAME: SOUTH SHORE HEATING&COOLING ADDRESS. 57 White's Path, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL info(a southshoreheatingcooling.com 7 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 CITY: r bAtg L) L MA. DATE: 3- is-104 PERMIIT'# 5L ' JOBSITE ESS:a toI15. 128• EMAME: 61/1.c Y _ GOWNER ADDRESS: IAlder 1(4 4friettite, TEL: °Ot,i-`1146- Z X��JJJ TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[J PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:B' PLANS SUBMITTED: YES❑ NO Er- 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 'j_ GENERATOR GRILLE VI INFRARED HEATER LABORATORY COCK • MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ -.1 ROOF TOP UNIT fi TEST `.Z* UNIT HEATER _ UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES.Ef NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY..er OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVE•:I. aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massa husetts General Laws,. + at my signature on this permit application waives this requirement A1L 1 _ LIACOAA't CHECK ONE ONLY: OWNER ❑ AGENT SIGN URE OF OWNER OR AGEi,T 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 mpli with all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. (/ � PLUMBE GASFITTER NE:_ . LICENSE# 6 1 W G U1 COMPA Y AME: AD61i6S: L)11.t `e5 CITY: ✓ STATE: 1"14' ZIP: 01ntf FAX: TEL: (CELL: EMAIL: MASTER Er JOURNEYMAN❑ LP INSTALLER❑ CORPORATION El# .3.6R1 PARTNERSHIP❑# LLC❑# E hi tic. ADD.ec SS: .14 6.7" 4-cit.4011n1CCOUv "Cg5k