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Home My WebLink AboutBLDG-21-004308 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 30,2021 PERMIT# BLDG-21-004308 JOBSITE ADDRESS 136 WIMBLEDON DR OWNER'S NAME GUIDE JOSEPH A G OWNER ADDRESS FEDERICO DONNA M 14 HERITAGE DR WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY j 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE 1 1 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 1 1 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❑ 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 Farricy LICENSE# 15042 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Peter F Farricy ADDRESS. 91 Middlesex St, CITY Millis STATE MA ZIP 020541015 TEL FAX CELL EMAIL i 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 . \ 1--c:- . 2 � C iS MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r� Vtt-9. CITY: Gre1(iv-' MA. DATE t i° 2f PERMIT# 8uX-7--,I'6v/Y-I 3 0 JOBSITE ADDRESS: 13 1.2• 6 lc i-ti 5.1` OWNER'S NAME: 1'(-A 4.(/` GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL-} PRINT CLEARLY NEW:1 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO a APPLIANCES-1 FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE i DIRECT VENT HEATER DRYER FIREPLACE [ _ FRYOLATOR _ FURNACE r f. _ GENERATOR ( , GRILLE VI INFRARED HEATER W LABORATORY COCK MAKEUP AIR UNIT q OVEN r POOL HEATER _ ROOM I SPACE HEATER -.1 ROOF TOP UNIT fi TEST Z UNIT HEATER 14.1 UNVENTED ROOM HEATER WATER HEATER f f INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES c'NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY-S}- OTHER TYPE 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. 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 worts and installations performed under the permit issued for this application will plIan I Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: LICENSE# I-5-b14- SIGNATURE COMPANY NAME: e,-r.`y of #I ADDRESS: PO /3,,,, 40 Z CITY: 11,.!i STATE: /lc ZIP: J�02Q 1 FAX: TEL: CELL: EMAIL: g - F,lh� g f f-1.4. /, MASTERS--JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# ink ftlg TT U—.� _� E 117Iv ADLVZc 55 : I c Li rncec.- r-16,- y r� eyUILDING DEpARTRAENi.