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HomeMy WebLinkAboutBLDG-21-006502 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ILeLs CITY YARMOUTH MA DATE May 10,2021 PERMIT# BLDG-21-006502 `-' JOBSITE ADDRESS 65 TANGLEWOOD DR OWNER'S NAME DIGREGORIO JOHN F G OWNER ADDRESS DIGREGORIO JUNE ANN 5 GRANDVIEW CIR FLEMINGTON NJ 08822 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 I SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER , OTHER 1 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 Troy Gilbert LICENSE# 13573 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: COASTAL MECHANICAL ADDRESS. 21 L Fruean Ave, CITY WAREHAM STATE MA ZIP 025711324 TEL FAX CELL EMAIL lisa ancoastalphc.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i -2(-OC)(osO1— CITY LWest Yarmouth I MA DATE f 05/07/2021 PERMIT # t3L C3 JOBSITE ADDRESS 65 Tanglewood Drive OWNER'S NAME John DiGregorio �aa GOWNER ADDRESS same 211TE FAX W TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ; 1 RESIDENTIAL ' / .1 PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESF---j NO® APPLIANCES -1 FLOORS--, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ,...,,. _. a . .4 BOOSTER li . CONVERSION BURNER i COOK STOVE ... __ DIRECT VENT HEATER r_____ IFr e DRYER _ FIREPLACE FRYOLATOR r .-1.-. _- _ ._.. FURNACE ,111 GENERATOR " GRILLE I INFRARED HEATER , _ LABORATORY COCKS . _„ MAKEUP AIR UNIT _ , OVEN POOL HEATER ROOM / SPACE HEATER jam, ROOF TOP UNIT i .�__, TEST 1 _ _ _ --�, -- UNIT HEATER 4 aiC _ L UNVENTED ROOM HEATER ul WATER HEATER OTHER l Relocating Meter 1 —1[ 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO El I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 'j 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 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. /� /7/Q tte— PLUMBER-GASFITTER NAME TroyGilbert ' LICENSE #1 13573 f SIGNATURE MP i MGF JP -7 JGF 0 LPGI ,,I CORPORATION [j# PARTNERSHIP # LLC '_ # 4350 COMPANY NAME: Coastal Mechanical 4 ADDRESS 21 L Fruean Ave CITY South Yarmouth ; STATE ,M-A-1 ZIP 02664 ITEL 508-737-8747 FAX I CELL 508-850-6955 EMAIL lisa@coastalphc.com