The URL can be used to link to this page

Home My WebLink AboutBLDG-21-006902 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tr CITY YARMOUTH MA DATE May 27,2021 PERMIT# BLDG-21-006902 fr JOBSITE ADDRESS 1101-5232 HEATHERWOOD OWNER'S NAME HEATHERWOOD CONDO MAIN G OWNER ADDRESS CIO DORCAS MCGURRIN 100 HEATHERWOOD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ 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 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 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❑ 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 Alfred Stello LICENSE# 21761 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 249 Oak St, CITY Harwich STATE MA ZIP 02645 TEL FAX CELL EMAIL none ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El El FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -iNtIii-E1-7- CITY: / f/'1 /U 1" / MA. DATE ,-$ �4,/ PERMIT 1-1 T vo(‘'Cr6Z JOBSITEADDRESS:/4'l hie.,4/.5`'C'/esvfCl1 OWNERS NAME:V� ,i4't �A'lj� GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:El--' PLANS SUBMITTED: YES❑ 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 V} INFRARED HEATER _ L LABORATORY COCK . MAKEUP AIR UNIT _ OVEN _ , POOL HEATER ROOM/SPACE HEATER _ _ -.I ROOF TOP UNIT fi TEST , UNIT HEATER r,U 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 0 NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY El 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 applicationwill be in corn liance� Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER/GASFITTERNAME4,66 ,7) ��--%4C' LICENSE# /, / SIGNATURE COMPANY NAME:f�'d2J--,e G!/t 4} ADDRESS:/k7 f7 ',a;;;S i i .P ciTY7�1�{,-tle4% 9 19447 STATE:,/t 4/ ZIP: :,96/t7 FAX: TEL:dO epe— .qa!DELL: EMAIL: MASTER❑ JOURNEYMAN El LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑ c h'J/9/L ADD2c SS . /N 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 I