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Home My WebLink AboutBLDG-21-003310 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK __ Ci CITY YARMOUTH MA DATE December 10,202( PERMIT# BLDG-21-003310 JOBSITE ADDRESS 35 KATHARYN MICHAEL RD UNIT4 OWNER'S NAME AVEZZIE JAMES L G OWNER ADDRESS AVEZZIE SUSAN L 145 INDUSTRY AVE SPRINGFIELD MA 01104 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO 0 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 1 FRYOLATOR FURNACE GENERATOR 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 El 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 Gonyea LICENSE# 15720 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PETER R GONYEA ADDRESS. 12 MARGARET JOSEPH RD, CITY YARMOUTH PORT STATE MA ZIP 026752440 TEL FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No ��S! 'k l Z'!t J2 oio THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /tl�i£l� fi/7/£ /fit-44 ✓r FEE:$ PERMIT# CEO V£7-£4-to2 /r/ /L M t/z-E r 1ncA PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - C J CITY: GX_c 'cc\(`) LA2,C—\CN MA. DATE\a' 3 -- PERMIT# 06� (�'Ai 0 3 310 JOBSITE ADDRESS: mac)) j fln. "•/ n,. � NR'SNAME: St..-tv‘_-eS e_ GOWNER ADDRESS: 'YJ Zsi\ \c1r.z-e-\ TEL�1,3-`783'�6 't5 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL] EDUCATIONAL ❑ RESIDENTIAL Te' PRINT CLEARLY NEW:Er RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES7. FLOOR- Bsmt 1 2 I 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 COCK MAKEUP AIR UNIT OVEN • POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST _ UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY El 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. & �.�aa � CHECK ONE ONLY: OWNER l' ElAGENT SI ATURE 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 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. ' ,y i.(id LICENSE# 7%�rr SIGN/PLUMBERIGASFITTER NAME: . R � ✓��c �e..e� SIGNATURE COMPANY NAME: ---"d-esss. ADDRESS: /a CITY: STATE: ILIA- ZIP: O24 7 FAX: TEL: Lek-37 0877 CELL: EMAIL: MASTER❑ JOURNEYMAN[r LP INSTALLER❑ CORPORATION 0# PARTNERSHIP❑4 LLC❑# 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