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Home My WebLink AboutBLDG-21-007270 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK % CITY YARMOUTH MA DATE June 15,2021 PERMIT# BLDG-21-007270 JOBSITE ADDRESS 23 PINEWOOD RD OWNER'S NAME TRABUCCO ROBERT C G OWNER ADDRESS PEASE-TRABUCCO CAROLYN 11 STONEWOOD LN BRAINTREE MA 02184 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 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 ❑ 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride@gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 1=1 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES ,„- MkilA xSACHU TTS LIMFORWI APPL€4:AT€ON FOR A P ROW TO PERFORM GAS FITTING WORK `,._,. ." C[T`( VV' et r� ay k , DATE / PP-6/11T LD C°--1-"o12:7 ° L. �1--a• ,6� W. r JOL'SITE ADDRESS 2 `J PI f\-e ea) OWNER'S NAME 44° 1- (‘ 60 cc-- - OWNER ADDRESS .----,.. 1114 :e ..--/-- /' Ay TYPE T � � OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL r_I .• .CW'RLY_---ta f -- RENOVATio ❑ -. -. tAcEt r: - - PLATS SUUVI : YE§ No- . - t i APPLIANCES FLOORS--f BSMv1 1 2 3 4 5 6 7 8 9 10 '11 12 13 i BOILER BOOSTER CONVERSION BURNER, COOK STOVE , DIRECT VENT HEATER , i_____, DRYER _ i FIREPLACE FRYDLATOR FURNACE I GENERATOR J GRILLE INFRARED HEATER. LABORATORY COCKS MAKEUP AIR UNIT OVEN r POOL HEATER I l ROOM ; SPAC:E HEATER , ROOF TOP UNIT TEST . . _ -._. . . UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current Iiabiiity insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW POLICYOTHER TYPE INDEMNITYBOND n I LIABILITY INSURANCE 1 1 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. I CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT J 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 al Pertinel provision of the Massachusetts State Plumbing Code and Chapter 142 of t General ows. .JUL , ' 1Lt PL UMBER-GASFITTEP. NAME im I IQ e& itt - r! LICENSE # / SIGNATURE MP ❑ MGF ❑ NJP 14 JGF ❑ LPGI 7 CORPORATION ❑ #F PARTNERSHIP 0 #r LLC ❑ # _ 0--).., („its, D4.4+ ADDRESS9 RA) 51-16, _ (tite IfI E AcoI�II�AN� r, 0 ; .., _, STATE ZI m 6 p0 3 TELGITY la � �'v" 7) li q ( i) t I (--X"- - EMAIL CELL -f'M h '{ L (L - FAX E � � A \ TJ 1 I i I a. �1 sww. iPit I (...) I , i I i i 1 7- z CJ I c'l `_ Dri a Dra 4 ! w s F I.. cap u) w .. 4 a o al M a, Ili — ILII U-1cep ll Ca I 0 I W I C ! 0 0 I I