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Home My WebLink AboutBLDG-23-001219 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�' CITY _YARMOUTH J MA DATE September 06,202 PERMIT# BLDG-23-001219 I_I JOBSITE ADDRESS 20 PERCH POND WAY OWNER'S NAME LAPRIORE JOSEPH A G OWNER ADDRESS LAPRIORE CHERYL M 27 BIRCH LN SHREWSBURY MA 01545 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 1 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 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 ❑ 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 Joseph Lapriore LICENSE# 9870 SIGNATURE MP El MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: LAPRIORE PLUMBING ADDRESS. 27 Birch Lane, CITY (Shrerwsbury STATE MA ZIP 01545 TEL FAX ( —1 CELL 17746968029 (EMAIL ioeplb(cioutlook.com S310N M31A321 NVId #lIW2i3d $.33d ❑ ❑ 1.1VC3d 111 SV S3AH2S NOI1VOIlddV SIH1 oN SeA S31ON NO1103dSNI 1VNId AINO 3Sf1 a0103dSN1 NOd 30Vd SIH1 S310N NO1103dSNI SVO HOf10N — MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I --4107-,:617-7, -.. ... VL _ i,,Z#4'to� I U�/ MA, DATE 94. ��— PERMIT # i Z 1 C sER 0 6 2 22SIT 4 DRESS OWNER'S NAME 3rZ 2,1 U. OWN A RESS 4,20 Ae.,..fi /"oI( 71 Gc-,�¢ TEL FAX DEP RTMEN T nen — CCttN Y TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: [ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO APPLIANCES 71- FLOORS-4 BEM 1 2 3 11 5 6 7 8 9 10 '11 12 13 1'! BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER ' DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR Acltfq91. GRILLE • INFRARED HEATER LABORATORY COCKS A- MAKEUP AIR UNIT OVEN . POOL HEATER ROOM ; SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER �----- WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of lVIGL. Ch. 142 YES NOI ❑ 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 f AGENT ❑ SIGNATURE OF OWNER OR AGENT Iv 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 compile e with all Pertinen rovision of the Massachusetts State Plumbing Code and Chapter '142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# 96970 SIGMA RE MP MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ #F PARTNERSHIP ❑ # LLC ft COMPANY NAME - Z4fc,, ç ADDRESS JOPSXcile-Mit-,Gr..,97 CITY Ai4 vtol/r h / 4Ai STATE 'MA ZIP TEL FAX • CELL 71(-C l PI EMAIL ,emu _,eve 4--/-7-I %M Co ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes N THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES •