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Home My WebLink AboutBLDG-21-007193 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK lT-.C, CITY YARMOUTH MA DATE June 10,2021 PERMIT# BLDG-21-007193 tfa/ am. JOBSITE ADDRESS 12 ELDRIDGE RD OWNER'S NAME PRATT MARILYN D(LIFE EST) G OWNER ADDRESS 87 LORRAINE DR EAST BRIDGEWATER MA 02333 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 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 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 Dean Farnham LICENSE# 13203 SIGNATURE MP Q MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC El# COMPANY NAME: DEAN P FARNHAM ADDRESS. 8 WILLOW WAY, CITY SOUTH DENNIS STATE MA ZIP 026603060 TEL FAX CELL EMAIL deanfarnham56(n gmail.com 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 ''. IaiIASSAC USETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I rn ,j,..„.,.....-, --4-A-L=t ' ,j CITY j"C,-t'#4 c 4-,� MA DATE ‘—/C3— a PERMIT r ter' ,_ ,, JOBSITE ADDRESS /2 /c.f."/ d e /7 �1 OWNER'S NAME 4 ', l rt /°>IC l7` G -�� OWNER ADDRESS TEL FAX e TYPE On �,- OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL (�� NEW'n '1 OVATTC N'' LAC % :' NO u — . . . ,-, \L L FLOORS-I BSM 1 2 3 1 5 6 7 0 9 , 10 11 12 '13 1 4 BOILER BOOSTER ________I CONVERSION BURNER COOK STOVE . DIRECT VENT HEATER i DRYEP, FIREPLACE ' I FP,YC�LATOR I FURNACE GENERATOR GRILLE I INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM ; SPACE HEATER ! ROOF TOP UNIT TEST _ . UNIT HEATER LINVENTED ROOM HEATER WATER HEATER I l OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements at MGL. Ch. 142 YES NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY DTHER TYPE INDEMNITYn BOND n I I 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, I • ti CHECK ONE ONLY: OWNER Q AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tru nd acc rate to the best of myknowledge e J `, and that all plumbing work and installations performed under the permit issued for this application will be in com lance ' a Perti ' n of the ~`• Massachusetts State Plumbing Code and Chapter '142 of the General Laws. i Q 1 PLUMBE - ASFITTER NAME LICENSE # /32, v3 SIG ATURE MP ! MGF 7 JP ❑ JGF n F LPGI 7 CORPORATION ❑ PARTNERSHIP ❑ r LLC ❑ # COIVIPANY NAME De,a A l'n 4c -... AC /-4- ADDRESS //c...-s,t c---... CITY -S- QP4 et ,5 STATE/7A ZIP 6)A fP TEL TEL ! FAX E AY 77ZS ciC (� EMAIL T 4-d-w 7 c--t. 5 r G rte-vZ.�, ....an, -t I I • I C1 Imo, 4_�,- I F" I . car I . I 47: I Ia. 1 I i I 1 I i i I I -a i In Eri o 4 w I cn Q E CO "C I Cr.), -a C IE. R. GrS IE6 1 III I-- U.. I 0 4� H 1 C) I • I C.1C I CA I Cn I I 1 0 I