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Home My WebLink AboutBLDG-21-004307 (2) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'La , CITY YARMOUTH MA DATE January 30,2021 PERMIT# BLDG 21 004307 1, JOBSITE ADDRESS 78 HERITAGE DR OWNER'S NAME ARDITO CHARLES J TR G OWNER ADDRESS ARDITO FAMILY TRUST 78 HERITAGE DR WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 1 DIRECT VENT HEATER DRYER 1 FIREPLACE 2 FRYOLATOR _ FURNACE 1 GENERATOR 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND 0 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 Ross Donaghy LICENSE# 15801 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ROSS A DONAGHY ADDRESS. 205 BARKER RD, CITY E WAREHAM STATE MA ZIP 025381286 TEL FAX CELL EMAIL ross.donaghyOyahoo.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 MASSACFIUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK (L' 6,T. ` CITY 4'rNed I� , DATE 6P / 2- PERMIT# .. ,f / ,u E -: i" JOBSITE ADDRESS 78 t e r6t OWNER'S NAME �� - OWNER ADDRESS TEL FAX w' TYPE O OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALb ° ..t _ _.j 1, _- .. PLANS SUBMITTED:-YES El NO❑ APPLIANCES`.I FLOORS-4 BSM 1 2 3 1 5 6 7 8 9 10 11 12 •13 14 BOILER — i BOOSTER I CONVERSION BURNER 1 COOK STOVE _ DIRECT VENT HEATER L—I DRYER _ i FIREPLACE FRYOLATOR FURNACE GENERATOR _ J GRILLE INFRARED HEATER -----I LABORATORY COCKS - 1 MAKEUP AIR UNIT I OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST .. T_. UNIT HEATER UNVENTED ROOM HEATER 1 iI WATER HEATER OTHERI 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 ❑ NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYYZ, 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 i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 1 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- .the best of my knowledge `; and that all plumbing work and installations performed under the permit issued for this application will be in complian.- ) 'th a inept provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `mot ....,._, PLUMBER-GASFITI-ER NAME LICENSE# /5 8O — SIGNA i s ,� MP K MGF❑ JP JGF❑ LPGI CORPORATION❑# PARTNERSHIP❑# LLC❑# � COMPANY NAME Ce ��1 a f=e.i4 ADDRESS CITY P U/v 9�° 1.._ STATE LI N Q2-5 .? T L qO 831 `7 ct%P FAX CE(._5d0 2 /- — 7314 EMAIL CO 55 ,C10 Agt. 6' ya 4.0 .Cam` ROUGH GAS INSPECTION NOTES THIS PAGEFOR INSPECTOR USE ONLY FINAL r3ftc 3>0I Yes A THIS APPLICATIONS S AS T RIT ❑• FEE: $ PERMIT# PLAN REVIEW NOTES 4 } I ) \ !