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Home My WebLink AboutBLDG-22-000488 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE July 27,2021 PERMIT# BLDG-22-000488 • JOBSITE ADDRESS 46 PLEASANT ST OWNERS NAME REILLY JAMES J G OWNER ADDRESS CIO J MCLELLAN P 0 BOX 372 SO EASTON MA 02375 TEL F TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 El BOND ❑ OWNERS 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Andrew Cameron LICENSE# 31643 SIGNATURE MP❑MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ANDREW J CAMERON ADDRESS. 1 FITZGIBBONS LN, CITY ROCKLAND STATE MA ZIP 023701968 TEL FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No sjk 7/z.7/2/ Gt`_i' THIS APPLICATION SERVES AS THE PERMIT 0 El /%l 3o FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _�" CITY ` I'VICU MA DATE 1 IV 12A PERMIT# JOBSITE ADDRESS SST OWNER'S NAME G-1 ( y� �f � I��1r-t'// t:r LJ OWNER ADDRESS `i; (Jqe1'7i 3f TELOZG7' 'S1,9 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO o—I APPLIANCES 1 FLOORS BSM 1 2 3 1 5 6 7 B 9 10 11 12 '13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRY OLATOR FURNACE GENERATOR GRILLE —T INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN E C E I V D POOL HEATER • ROOM I SPACE HEATER 29 21121 ROOF TOP UNIT TEST - . .... . . .- -, UNIT HEATER obit [57t'u= t7EPARTrvi,E�T e� INVENTED ROOM HEATER WATER HEATER OTHER —J 1 i" /'VI/ flt(1 fte pp-4 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of WI..Ch.142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. CHECK ONE ONLY: OWNER ❑ AGENT El 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 ccura to the best of my knowledge `- and that all plumbing work and installations performed under the permit issued for this application will be in compli nc. 'th I ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Q l PLUMBER-GASFITTER NAME LICENSE#3l 6 q) 'IGNATURE MP ❑ MGF❑ JP JGF LPGI❑ CORPORATION❑It PARTNERSHIP El# LLC❑ COMP IVY NAME 1 VI P Q,I'ltt �[A, ADDRESS �Q C 1 4 CITY U STATE \MI ZIP 07_370 TEL K)ri 37 5114 FAX CELL . - EMAIL /JN►r liin c (\ t (C(' 1 1Z3 /v d/ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATIOI`d SERVES AS THE PERMIT ❑ ❑ FEE: ` PERMIT# PLAN REVIEW NOTES • • - " • OMMONW LTH OF M HUS i • , DIVISION OF PROFESSIONAL LICENSURE 1 BOARD pF PLUMBERS:•:.. . , ISSUES THE FOLLOWING LICENSE ...... .... .:•. :•:•••:•:, •••• •••. .•••• •• ••• JOURNEYMAN PLUMBER , •••••••• ' a AN.OREW J CAMERON: •••••••• . • IFITZGIBBQNSLN • ROCKLAND.,,MA dir441 • :•:•:•:•• ••:•:••• •••••:-: ••••-• ••• ••• ••••• 31643 /2022 ,,, 841715 •••••••:':'::::1:. • s : • • •