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HomeMy WebLinkAboutBLDG-23-05968 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK F' ` ' CITY YARMOUTH MA DATE April 27,2023 PERMIT# BLDG-23-005968 � r JOBSITE ADDRESS 15 PEREGRINE LN I OWNER'S NAME CRIVELLI ANDREW H G OWNER ADDRESS ICRNELLI JANICE G 12 BOULDER BROOK RD EAST SANDWICH MA 02537 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 NO FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 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 Saunders LICENSE# 4546 SIGNATURE MP❑MGF©JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: SEASIDE GAS SERVICE INC. ADDRESS. 67 HELMSMAN DR, CITY YARMOUTH PORT STATE MA ZIP 026752467 TEL FAX CELL EMAIL seasideuaslthcomcast.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 , __-Z141. k I t - HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , _47 -„ a' i CUtH MA DATE 4/25/2023 PERMIT # L -23 "00 9c,F 8 ' � , m w 'J E LDD' ESS` PEIZECse_AINE LiciN OWNER'S NAME iVic, guo-G fa> B U I GTG D 2 i Wfo ale 0 ' ESS 5inovIE TEL . t Qo FAX PRINT OCCUP4 1 ' TYPE COMMERCIAL;. EDUCATIONAL RESIDENTIAL> CLEARLY NEW: RENOVATION: . REPLACEMENT: X PLANS SUBMITTED: YES. (,: NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER f CONVERSION BURNER ' r COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE , FRYOLATOR ` FURNACE t GENERATOR I s , GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT 1 OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT 5 i TEST .. .._. . _ ___._ ._ UNIT HEATER , UNVENTED ROOM HEATER ,. f . . .. ......... WATER HEATER f OTHER f i 1 i ,. , ii INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I v NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v OTHER TYPE INDEMNITY . BOND I 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 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 t. e *es if my k,.wledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with - 'e ' lent rovis':, of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 3860 J -40 -gailrer PLUMBER-GASFITTER NAME :Kevin Saunders 1 LICENSE # 4546 M i S .iiATURE MP MGF v JP JGF ' LPGI CORPORATION x # 302 PARTNERSHIP "# LLC # COMPANY NAME: Seaside GasADDRESS Service, Inc A S 67 Helmsman Dr CITY Yarmouth Port t STATE !. MA ZIP 02675- ... TEL 1508.771.2768 I FAX Y CELL$508.400.0943 1EMAlL[ ERMlTSseas!deasservice