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HomeMy WebLinkAboutBLDG-23-002891 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `^Pdri CITY YARMOUTH MA DATE November 28,202]PERMIT# BLDG-23-002891 JOBSITE ADDRESS 31 POND ST OWNER'S NAME Isabella Marino G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 ❑ 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 Kevin Thibault LICENSE# 1117 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI © CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: KEVIN G THIBAULT ADDRESS. 237 CRAWFORD STREET, CITY FALL RIVER STATE MA ZIP 027242310 TEL FAX CELL EMAIL kenivthibault5(a,comcast.net 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 ., s Iq HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `: q_= 4._.�. CrrY "YOUTH ... .. MA DATEI11/23/22 PERMIT # ' OV 2,�N+:II2 AD, R SS 31 POND ST _ 'OWNER'S NAME ISABELLA MARINO I f3 ING D� � A '.fE S SAME TEL 508 246 8459 'FAX' 1--- OnZi5Ai PE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: v RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES -1 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 i DRYER —,-- ,.„,._-,.. ,�_ -ors. K, , snow _ _.__ .. inner FIREPLACE i FRYOLATOR `" FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS 3s . _inomw _mow MAKEUP AIR UNIT '' - ,r.. Assrm- �.. ,q,. �.a • OVEN POOL HEATER ROOM / SPACE HEATER _ ROOF TOP UNIT 4111MINE' Mr IOW TEST UNIT HEATER UNVENTED ROOM HEATER 9 I, .ar,,,— .wry ]•yL. -.ry,- .- _:.. -., °.. ..,T.... . :.. .. WATER HEATER _ _ OTHER . UG LINE FROM TANK TO HOUSE i .; } INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES F NO ro 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 fl 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 KEVIN THIBAULT LICENSE # 1117 I SIGNATURE MP MGF JP JGF L LPGI w ' CORPORATION r---' # PARTNERSHIP;,, # LC L#, an�rrnr�-rr ,,,.- COMPANY NAME: OSTERMAN GAS I ADDRESS 42 FIRST ST CITY BRIDGEWATER 1 STATE MAj ZIP 02324 'TEL 1508 697 3131 FAX CELL 508 916 0843 1 EMAIL KENIVTHIBAULT5lnW COMCAST.NET 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