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HomeMy WebLinkAboutBLDG-23-003954 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK V BLDG-23-003954 r� CITY YARMOUTH MA DATE January19,2023 PERMIT JOBSITE ADDRESS 59 PARKWOOD RD OWNER'S NAME Felix Lidonni G OWNER ADDRESS r TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 1 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 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 BRADLEY TOMASETTI LICENSE# 16544 SIGNATURE MP El MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑tt LLC❑# COMPANY NAME: TOMASETTI PLUMBING ADDRESS. 103 UNION ST, CITY YARMOUTH PORT STATE MA ZIP 02675 TEL FAX CELL EMAIL tomasetliplumbincagmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �='=Yz+ g CITY > "T L �/ "Sr1 S Ll / G.r,v ti �/"7 MA DATE �/l`//Z CZ,..; � PERMIT ; Z JOESITE ADDRESS 5 I 1-7.-k vn p tj /fit ' OWNER'S NAME Qcitii 2/2i GOWNER ADDRESS TEL el^ FAX OR TYPE PRINT PE OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q./ CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ] NO❑ APPLIANCES 1 FLOORS-F BSM 1 2 3 1 5 6 7 B 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER I COOK STOVE / —� _ DIRECT VENT HEATER DRYER FIREPLACE —j FRYOLATOR FURNACE GENERATOR GRILLE - INFRARED HEATER ______ LABORATORY COCKS __________I MAKEUP AIR UNIT I OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST . UNIT HEATER ......... .._ .. _.._ UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES iO ❑ 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 • II Massachusetts General Laws,and that my signature on this permit application waives this requirement. i CHECK ONE ONLY: OWNER ❑ AGENT ❑ •-., SIGNATURE OF OWNER OR AGENT 1•• 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. Li 1, PLUMBER-GASFITTER NAMEX-tcP 7e,...,4 s-C LICENSE tr`�5-d y J SIGNATURE 1 MP ! " MGF❑ JP ❑ JGF❑ LPG' ❑ CORPORATION ❑0 PARTNERSHIP❑0 LLC❑0 COMPANY NAME TOw+G Sr f P/4r,, h.,3 s ADDRESS l u 3 ., r al St— CITY iin du 71-4 4'1" STATE A U ZIP 0Z4 7S TEL FAX CELL 5-0E-`jZZ'- L/OOf EMAIL 4 (' iuw I. �cl �F� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT # FLA[ REVIEW NOTES