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Home My WebLink AboutBLDG-23-002897 — MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY YARMOUTH MA DATE November 28,202;PERMIT# BLDG-23-002897 JOBSITE ADDRESS 27 OUT OF BOUNDS DR OWNER'S NAME BANKS RICHARD W G OWNER ADDRESS BANKS KATHLEEN M 27 OUT OF BOUNDS SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 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 0 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 Francois Paravisini LICENSE# 15211 SIGNATURE MP 0 MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: FRANCOIS PARAVISINI ADDRESS. PO Box 2585, CITY Orleans STATE MA ZIP 026536585 TEL FAX CELL EMAIL baysidet thecapecodplumbers.com 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 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT ERMIT TO PERFORM GAS FITay m.771v1E-- TAlifk- -;4 CITY ING TTING WORK YAr 1'1eszi . _ MA DATf]J -T7_ j _ ''= `ePERMIT # Z- S L '6 `I i JOBSITE ADDRESS131 ------.7------.-- j F OWNER'S NAME e M __.... G OWNER ADDRESSL TES j�� c f - - 13 TYPE OR . ; _ r.._.J. - ,......r..._..: �_ _ vI��`zF'4X OCCUPANCY TYPE -- - � ��_M PRINT COMMERCIAL [ j EDUCATIONAL L ` € RESIDENTIAL(,r CLEARLY NEW:17,2( RENOVATION: �� -- L, REPLACEMENT: [�,__1 PLANS SUBMITTED: YES (�j NOD APPLIANCES Z FLOORS-. BSM 1 2 3 4 BOILER wri"---------1- W 56 7 $ 9 10 11 13 14 BOOSTERilli i � ,.�.. w_�._ -, ,.__-�-� { _ ...., iiiiir i CONVERSION BURNER ] _ �� i ]COOK STOVE � --C DIRECT VENT HEATER DRYER FIREPLACE �- - - I: FRYOLATOR 't _. ..�. t ..a ' � _� I AIM FURNACE GENERATOR J WAITIMIIINCOMMINIMIMIMMOWIMMOIMIM GRILLE 1 =MIZAZ INFRARED HEATER _ —1X) LABORATORY COCKS ma. . ] RE MAKE UP AIR UNIT IIM _ OVEN M]sumna MORIM I � POOL HEATER � �,� � - _ . M� �� WMW ROOM /SPACE HEATER � ��W ROOF TOP UNIT � � TEST i M j0.1 J � . _ . M - -, UNIT HEATER UNVENTED ROOM HEATER �� MIIIIIMM _ WATER HEATER M MM� �� OTHERItami _ _ �.1 iI i M MIN�� 117.77'77""'"-- - -- INSURANCE COVERAGE MI II I have a current liability_insurance policy or its substantial equivalent which meets the requirements I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGEq nts of MGL. Ch, 142 YES � NO [� BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY j_ OTHER TYPE INDEMNITY L I BOND Li OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insuranc Massachusetts General Laws, and that my signature on this permit application s coverage required by Chapter 142 of the waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ; AGENT Li ��.. I hereby certify that all of the details and information I have submitted or entered regarding this application are true 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.P p and accurate to the best of my knowledge LUMBER-GASFITTER NAME Francois Paravisini ~ LICENSE #C15211 I SIGNATURE JGF Li LPG'LI CORPORATION ! i# 4288 PARTNER-------------j.. --, __,...,1 ._._._ SHIP i LLC f �#i _..ANY NAME: Snows FuelCo .11.1 COMP �18 Main St �"` - -- CITY Orleans MAADDRESS STATE _. - I 111 ` MA ZIP 02653 TEL 1508-2 .�'� __ _ . JcELL[ 55-1090.__. _ .__, 4 R EMAIL[Bayside@ecapecodpJ T..:ITI umbers.com W -