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Home My WebLink AboutBLDG-21-007169 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ��'�'�' $' CITY YARMOUTH MA DATE June 10,2021 PERMIT# BLDG-21-007169 • JOBSITE ADDRESS 27 SPRUCE ST OWNER'S NAME lori Cotten G OWNER ADDRESS MA 01519 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME michael pierce LICENSE# 34718 SIGNATURE MP❑ MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 4 kaycees way CITY west yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL mapierce774na,gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES —f ;_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PE RFORM ERFORM GAS FITTING WORK MET,' ^ CITY CI tr m ` a - L' 0/Z� MA DATE ( PERMIT # JOBSITE ADDRESS -2 7 5 P,v €L f" OWNER'S NAME in 19 to G OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL ❑ RESIDENTIAL 1' — CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO n APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 , BOILER i BOOSTER CONVERSION BURNER COOK STOVE 1 " DIRECT VENT HEATER DRYER FIREPLACE — r FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS 7--- 1, MAKEUP AIR UNIT OVEN POOL HEATER ROOM i 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 �O 7 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 7 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 ❑ 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. �Ii2 PL UMBER-GASF ITT ER NAME LICENSE # `> q 77/s-- E MP n MGF n p JP 11 JGF ❑ LPGI ❑ CORPORATION El # PARTNERSHIP [ 1 # LLC f 1 # COMPANY NAME1 ex- :�' �� C.- a) j I Y1.) .- /C1,c: ii t:1 ADDRESS t/ k-ci v C f C 1. ,c., , CITY " C)c..-)4- \16i r Ins k. '1-h STATE . trt 4 ZIP TEL`7_ ." TEL 7 7ci 7t1 _j j- I FAX CELL 7 *7 cl 7 1" 34-1 ti EMAIL A e .C'c Pit, n.71:vi/ 5(2 rt,' c _ �4.3 6l i/ c s in