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HomeMy WebLinkAboutBLDG-21-006658 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 18,2021 PERMIT# BLDG-21-006658 If— : JOBSITE ADDRESS 3 CAPT CHASE RD OWNER'S NAME jim mcgarry G OWNER ADDRESS MA 02048 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ 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 1 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 Gary Famigliette LICENSE# 10191 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: GARY FAMIGLIETTE ADDRESS. 67 MAPLE AVE, CITY HYANNIS STATE MA ZIP 026014403 TEL FAX CELL EMAIL FAMCORCOMCAST.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 -‘'5$71)-- b �► MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FiTT11NG WORK I --u-W' any _._ MA GATE 11)„la I � Purr 140 6- 2 oo��s N S C r f , JOBSITE ADDRESS'3 aft . C �S� imams NAME GMINERADDRESS L 1 _._ 17Bl 4x1 TYPE°R OCCUPAN,•Y TYPE COMIE &El EDUCATION Al_❑ RESIDENTIAL (',EARLY NEW G] RENOVATION C RERACELIENT:0 Puwssuei.rrE!): YES ua® APPLIANCES 1 FLOORS-. BSM i ' ' 2 ' 3 4 5 6 l 7 I 8 9 10 11 12 13 1 BORER - 1.111 BOOSTER COOK STOVE MI MI Min t MI ION OM OM NMI BM DIRECT VENT HEATER OM MN MINN INN INN DRYER 1111111 MB MEM um No MEN sum mu um am mu me , RRER.AcE ins am mum um um sion.NM NIN IINII INN NM ONE " m m m m M On o GRILLE M UN NM 1. . GRILLE � .� M� an ..rw�WM. INFRARED HEATTER INN MIN 111111 WM NM NM 1011 NM LABORATORY COCKS NM an dB 11111111111111111 Elm NM 1111 1.1 MN 011111111111 OMAKEUP AIR UNIT EN ON 11•11111111.111 MN En Eli Milli am um VEN Mao-- -11111111111--- � �POOL HEATER in 10.1111111110 No 1111111110 Eon all ' ROOM I SPACE HEATER ali MIIIIIIIIMS NM MINIMI_Nil go 'ROOF II UNVENTED ROOM HEATER MO NMI IIIIIIW NM OM MN 1.1.11ME INN WATER HEA 3. I ME NM IIMMIIIIIIIII 11111111111111 INN NI OTHER - --m- 11-ii MIMI inil Fill MIME Illialin 111111 i UNIT HEATER NI ill. MEM U. _ 1111111W 11111W UM INSURANCE COVERAGE I have a crrerd Lilstrance poky or as sttstarlial equivalent which meets the recp*esilents of MGL Ch.142 YES .' NO I F YOU CHECKED YES,PLEASE PI KITE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY - OT1ER TYPE INDEMNITY -: BOND ❑ OWNERS INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage regl:ed by Chapter 142 of the i Massachusefts General Lars,and that my signature on this permit appicalion wanes Ills regiment CHECK ONE ONLY: MI ER D AGENT t_ SIGNATURE OF OWNER OR AGENT 1 hereby eerily tad a8 of the&anis and rdonnabon 1 here subrdhd or erred regarting hrs appiralion are flue and macaw 10 he best of very inmate and hat a8 plian ig■ark and redid c pertonTd under he nem*issued for his appicaion a be it cq in7i a8 Perim ®t povon el he Stale Pkmbng Code aed Chapter 142 0l he C,areai� PLUMBER-GASFITfER NAME;Gary Famigielle Ii UCENSE#10191 1 SIGNATURE MP D MGF❑ _❑ JGF Q LPG❑ CORPORATION p#E PARTNERSHP # ilc an COMPANY NNE_IFamco 1 ADDRESS 467 Maple Ave CITY STATE Ma ZIP!02601 TEL 50B-T15.6625 FAX 1 CELL EMAIL jFemoo@aomcast net