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HomeMy WebLinkAboutBLDG-21-005810 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK or_ (,k,,, r CITY YARMOUTH MA DATE April 08,2021 PERMIT# BLDG-21-005810 `zzf JOBSITE ADDRESS 2 HEADWATERS DR OWNER'S NAME Aubrey Foster G OWNER ADDRESS 436 PEMBROKE WOODS DR PEMBROKE MA 02359 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 1 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 El BOND El 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 Dennis Gagne LICENSE# 9804 SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: DENNIS M GAGNE ADDRESS. 31 Cherrywood Ln, CITY Marstons Mills STATE MA ZIP 026481761 TEL FAX CELL EMAIL gagneamg51( aol.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 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ell CITY c1✓//44N MA DATE -i'Tl I PERMIT# BCD�..t1 -oo 5&i 0 JOBSITE ADDRESS' 2 ' Ja r C oC5 D r I OWNER'S NAME atk,(j p_eh 'R 1 OWNER ADDRESS !TEL TFAX 1 TYPE OR OCCUPANCY TYPE COMMERCIAL;] EDUCATIONAL _- RESIDENTIAL PRINT CLEARLY NEW:ar RENOVATION:U REPLACEMENT:^I PLANS SUBMITTED: YES NO_( APPLIANCES 7 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _I I_ _J_-.__ —J'__I I_1 I—J—j__J . t.—I__I BOOSTER -J I. 1: I t — '_ j J .� ____II �—J CONVERSION BURNER I I I I t.. I 1: ? I I__1_ _ :_J I COOK STOVE 1 I ?' DIRECT VENT HEATER i - 1.-1—J:— . _____1_-1 __1_ I I_ _ DRYER I I I_ . _. _I. 1 FIREPLACE - __ _I I_J I_ 1 I_ _J 1 !___I I .__I_____I_ J_._J FRYOLATOR _._t I 1-.____(—J I II I —J_ I J— I FURNACE !—�' I I I —1__l —— — I I I GENERATOR 1 I i. I I .- I 1 t I_ I I I ( GRILLE —�-_( I�_.1 ,`-!:,__(' '`�J —J _ .__ (.:___J. INFRARED HEATER __j 1',_J 1 !_� I'� l I __J__I_� I i _ I I_.._.____I_____I_ I ' I_ 1- LABORATORY COCKS [ - - �. - _.___i , it MAKEUP AIR UNIT _II I I I__J J.J I I __'l_ j i. I OVEN I 1 1 i-- - ,: __J_I I __ ii ? 1 1. _I______I 1 POOL HEATER I 1 I___.1 , 1 J�_I I 1�.J.______,'......_...1_ J J 1 ROOM I SPACE HEATER _.._1 I_ I I I ; _ I I. i I I I I I i ROOF TOP UNIT ' I I 1 l_— 1 I_I I I i 1. I TEST 1 I I i i _i_� i_ I I UNIT HEATER I ______2_ 1--J —I_.1 ___ 1 -J I—_J UNVENTED ROOM HEATER J I ! i [ J _._j ,__,1 I___j I J _-____.j 1 WATER HEATER - ------ --- - I 1 I. I j_._._._I-_ I_J I OTHER ; I I i . I I I I_I I ..I__-_._._.i__.__J I I I I • . 1 .. 1 1 .. _ I _I 1 _I 1_ I . . _ 1_I i L _ - - I _ L.I_ i 1 i ' __1 I_..__J 1 1 1 _. _ I 1 INSURANCE COVERAGE _ _ ZI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I 'NO "L I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY „F OTHER TYPE INDEMNITY _[ BOND i—.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 7 II AGENT U 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 A1/4,S y N., 1s6-6-11 LICENSE# Q 80'4 (-e_ i SIGNATU MP'MGF-j.3 JP _ JGF LPGI _ CORPORATION _4`3a3c"\ (PARTNERSHIP #-- LLC I#7- 1 COMPANY NAME:' j� I �p 1,\1CS 6+Ft —c- ADDRESS 1 ( C -h\P t- CITYe SI &j2rtloc STATE Y ZIP 3 6 1 3 -"TEL FAX I CELL,77�1- 2 EMAIL A.:2 A r^U a 0(. �v0,\ 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