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HomeMy WebLinkAboutBLDG-21-004304 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK V�a l CITY YARMOUTH MA DATE January 30,2021 PERMIT# BLDG-21-004304 JOBSITE ADDRESS 24 HASTING AVE OWNER'S NAME JACOVIDES GEORGE L TRS G OWNER ADDRESS JACOVIDES BETTY S TRS 5 WEST ST ARLINGTON MA 02476-7135 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ 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 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 1 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❑ 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 Cameron Natale LICENSE# 4600 SIGNATURE MP❑ MGF © JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. 200 Audreys Lane, CITY Marstons Mills STATE MA ZIP 02648 TEL FAX 1 CELL 7743537354 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 11 ❑ FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK _ l.lJ Z I-064 :3-ts y� cITY WEST YARMOUTH _ MA DATE.�.�Q/.�Q2:�..".",�PERMIT# JOBSITE ADDRESS-24 HASTINGS AVE _ , OWNER'S NAME �A.c.QVII) ,• ...,, ._,„ ,,.. . R G OWNER ADDRESS 24 HASTINGS AVE TEL., 727 688 4091 JFAX TYPE OR �py PRINT OCCUPANCY TYPE COMMERCIAL..„„j EDUCATIONAL;r RESIDENTIAL,,X CLEARLY NEW:,,,„ RENOVATION:`,1' REPLACEMENT:'] PLANS SUBMITTED: YES!,t NO.,,,,i APPLIANCES-1 FLOORS-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I I ,. l BOOSTER ,�_,,,_f € , -_-....,„1` —�•�- 1•Y-,� °.•�..-?�-a--r -, _._ .. � ..�-,.,� �.�.� ,._.l .( CONVERSION BURNER �-- -f X--_i .. Y I _ i COOK STOVE .__.. _ �_ .,-:5�--� � _..: � -•-•,n j, I � � -�- ��-:� �. ....:•...3-,,,,,,,1' ° :{'tF7R---11. i"^i v a 7•`yC�--+` -4- ,,., 1 ,: ^*�,... .�,." F si DIRECT VENT HEATER -s••---,{,rA v .anmr-t ,R..-�n.- .._ •s,-•s �--- ... r , .-a ... . DRYERrm ,C h'� t 1^r,.v,r „�I ... ,J_.g.. 4 ... .....-r _.. -r.^-r1 ..4 FIREPLACE f I... Ir ,,...,.QJ,.. _-.° � � ,, , FRYOLATOR - -:rsf: �r Y,k . 7 FURNACE - (£ ! �I,. ., , ...nt . ...::. ,.,w_1 GENERATOR :-i 7r7,.. ',� i - GRILLE ! T $ , ,, INFRARED HEATER LABORATORY COCKS -�r'.�.."„".,.� � -� ; - - ` ..7.J ,...�,• �'..• :r•.�••� -1, s�: '� ._...��v..: MAKEUP AIR UNIT ( I I ,._. I ,J_ _4:•7,-,,r)4.,.. -,,•:........._„_..........3' ' ,J J OVEN , ......_ -......,‘„.,.. 1 ...„....i__,...u..., 1 .4 � 1. ' t r 1 i «C POOL HEATER ,• -- z,x -•-n ,•-- . �. ROOM/SPACE HEATER .I' .1, •_ .1._�.` ••.. i {.„..,.....1, � ROOF TOP UNIT r-r .�. r f i : t .. TEST UNIT HEATER r. -1 „I.,— --�i.mr- �.- .r.l _ t' .•._, .. , -- x ,- 1 UNVENTED ROOM HEATER {p (t tt ] {{ i.- 1I4"PfY -7yR"'7 7� '6°."'"�." "--j 1l- :.i. 1lir'...,.....1i .. d d WATER HEATER .. . _1 1, 1. C ..�1 I €-�-..-..,,4 ,1 . .t•l OTHER .Lir - . •. ^ . .W S ,� -� . s`.aPear7r�r .. r .. -.. a," .- ' , d- , _. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES La NO ", I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ,.„„ OTHER TYPE INDEMNITY ,.,,j BOND LI 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 'L ,.: 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 accurat t of my kno edge and that all plumbing work and installations performed under the permit Issued for this application will be in complian all•• provi i e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME r CAMERON NATALE €LICENSE#.GF4600 r SIGNATURE t. MP . Ji MGF .1 JP;..,J JGF 1 LPG! t CORPORATION el 307 1 PARTNERSHIP,._,.I# I LLC, 1# COMPANY NAME: ROBIES HEATING&COOLING J ADDRESS 279 YARMOUTH RD CITY HYANNIS ."..". - STATE MA ZIP:02601 TEL 50&775-3083 FAX 508-534-1272 =CELL 508-775-3083 !EMAIL MAR1ROBIES,COM. __la- e_ !e 2 1 •1 ®_ L Br: _ DFP -. r;lr r tvr i 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