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HomeMy WebLinkAboutBLDG-21-004452 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k., f CITY YARMOUTH MA DATE February 05,2021 PERMIT# BLDG-21-004452 JOBSITE ADDRESS 7 DEEP BROOK RD OWNER'S NAME DRIGGS MICHAEL G OWNER ADDRESS 7 DEEP BROOK RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS BSM 1 2 3 4 I 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE • INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 0 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. 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 Ralph Giangregorio LICENSE# 9339 SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RALPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY Dennis Port STATE MA ZIP 02639 TEL FAX CELL EMAIL officeR3gsplumbing.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION Nt7TES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK gii x CITY ,,_I...2_,_-� L,, - . MA DATEL:A..:::2Lau PERMIT# 13Lb6 'Z ,-'bbi 4 JOBSITE ADDRESS INIUMI.,,,f_HrliMI __. ...._ ___ . OWNER'S NAME Lia t cc , ,,r r(i445,,i �S __ li GOWNER ADDRESS1...s.,„i'gatyvz._..c.............___.._._ TEit aQ q3 JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PST RESIDENTIAL El CLEARLY NEW:0 RENOVATION:U REPLACEMENT: 1 PLANS SUBMITTED: YESO NO12 APPLIANCES 1. FLOORS-, 8SM 1 2 ' 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - 1t )F _. ~BOOSTER f ?, .w-i , I.w.. .4 -rye..,+ ir -v'� *a,w411.rc`. wty ■r.,„ r .-.nr. ! -n-_nz•, CONVERSION BURNER [[ w 1 COOK STOVE NEL -- -- _ ,.r__ � . ' ' . am l� l— .I .. .i -11:4 _ I DIRECT VENT HEATER11.1111.0....11.1 .0111. ^J t'�' DRYER -- -;1- WI � -�1 � �Y . _.�_.� .� � FIREPLACE ,' ;, ^1=:= -r ik 1r:rTi ice` _ ..I:-� - .- . .. -= �r .__._ _.y FURNACEAlf ill_ • _ GENERATOR i _ 1. GRILLE . jt , . .� • �_a 'j-- - .�, . +' ,,, . X, - ►:. �. map 1 J: •c 1�.-•-r-. ____ _ I .a•'� ter.l•JP p.-.yrrrs.aI INFRARED HEATER - ;� - iI LABORATORY COCKS - E _ i i. MAKEUP AIR UNIT ` _ I OVEN - L - 1 - �. 1 Mill k ,,110�_ _• POOL - - - - - - - - HEATER __; ;�MI�� � -. ROOM t SPACE - -- - - - .,� ---- �,�_ _ -WO_ �=�-WNW# ��_=- - - ���.-- HEATER _ ._. . � .__ _ -- _� . . _ ! �I ROOF TOP - ---, ----- - ----,.— �� - -- - -�- - -- - ���� ITIMMILMIIM TEST glirWirMAt atir II fir WNW Mil UNIT NEATER - Will_ {-= ----1 . I �. _ II. _ .I L_,:i __ UNVENTED ROOM HEATER WI= 1: - 'r . C1:- _ 1i-.'Svl 4 `1.. .., ..i • :iL ] 1-Tt_7i:_ 'I` ]!� u....,:.- WATER HEATER - - 1 # P I !i tiJ OTHER . . {r_____--i �,. [. _ - ._ 1,„iriY�''i1e�]Sr.'-'..'..}Lsti„ --_ -- .- _ - :1_ — 1 t• —.1 _— •. .... ��_ , : ......._.,-- ,,,v:, .:,,:_ . ._. .--.. .._. -i . .... i' , if! ._ . . . . ... .. _.I __._` .. .i. . _ _ _ .__ if _ ..- i .. ._... 1 ,. . INSURANCE COVERAGE / 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES 3D f IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA -BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY fl BOND LI 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 0 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 ail plumbing work and Installations performed under the permit issued for this application will be in compliance with ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. % PLUMBER-GA T -- ' 'SFI TER NAME, Zc (� 1,_ ,. � , ., LICENSE # SIGNATUI MP M MGF 0 JP 0 JGF 0 LPG!El CORPORATION(J#1166._ -I PARTNERSHIP(1# -_- -J -Dili ,; COMPANY NAME: : ,()-3 - 1 r ` I ,ie . c \ ADDRESS 1 SSA' f Yl(;t� �fi ! -` : - - �s-e.e..w......_.-eve-r.y .de,..��ec...�, .yr..-. ��_. ._ .y.-,.vve� -r...... e..7-•-• v-......-w...__ f CITY II f S ►��. _ _, ,.... . .,.,.,_.-....Y_, STATE ; ZIP in ; 3 e TEL (7-'0 fi` r3` . 4-1 FAX SD r3 ci c CELL r__Y ..�JEMAIL1 - JQr.AL_ -1 1 `y________