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HomeMy WebLinkAboutBLDG21-006503 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k,,,�"4 CITY YARMOUTH MA DATE May 10,2021 PERMIT# BLDG-21-006503 rn s1_i-,i= "0 JOBSITE ADDRESS 309 PINE ST OWNER'S NAME robert pike G OWNER ADDRESS 309 PINE ST WEST YARMOUTH MA 02673 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 OTHER 1 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 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 Peter Garabedian LICENSE# 8875 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PETER D GARABEDIAN ADDRESS. 4 WHITEHAVEN LN, CITY WORCESTER STATE MA ZIP 016094407 TEL FAX CELL EMAIL officeRgarabedianplumbinq.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i. =era :-1 * , CITY Yarmouth 1 MA DATE 5/7/21 I PERMIT# iV-I� '-2(-�° 0 JOBSITE ADDRESS 309 Pine Street OWNER'S NAME Robert Pike GOWNER ADDRESS 502 Whittemore Street,Leicester TEL 774-314-0546 IFAX 508-755-7572 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL D RESIDENTIAL!] PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES❑ NOD APPLIANCES Z FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER i -4-- . COOK STOVE } �_ DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR >. FURNACE GENERATOR daddi_ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN i. POOL HEATER _ - ROOM/SPACE HEATER _ ^_ ROOF TOP UNIT TEST ,_._I UNIT HEATER UNVENTED ROOM HEATER __ WATER HEATER I OTHER (Gas Outdoor Fire Pit 1 t..._.f...._.E INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 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 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 rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �t PLUMBER-GASFITTER NAME Peter Garabedian I LICENSE#8875 SIGN MP 0 MGF Li JP❑ JGF❑ LPGI❑ CORPORATION Q# 1538 I PARTNERSHIP❑# LLC❑# COMPANY NAME:Garabedian Plumbing&Heating,Inc. I ADDRESS 208 Austin Street, CITY Worcester STATE Ini ZIP 01609 TEL 508-757-4803 FAX 508-755-7572 CELL 774-314-0546 'EMAIL office@garabedianplumbing.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