HomeMy WebLinkAboutBLDG-18-006181 ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
474-wi CITY }1.-Cw.ci.,i" MA DATE /0D PERMIT# 1,46-`Er-ad t e ist
JOBSITE ADDRESS , ' L)r. (i)e Ha) OWNERS NAME Pc_ulr- i et511cA
G AIs�:-/
OWNER ADDRESS v I5Tlf 4/e TEL FAX
TYPE OROCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[ i."'"°-
HUNT
CLEARLY NEW:❑ RENOVATION: i REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO g----�
APPLIANCES 1 FLOORS--t BSM 1 2 3 4 5 6 7 8 9 10 11 12 '13 16
BOILER —1
BOOSTER
CONVERSION BURNER,
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE i
FRY C)LATOR
FURNACE
GENERATOR
GRILLE I
INFRARED HEATER I
LABORATORY COCKS 1
MAKEUP AIR UNIT
OVEN i
POOL HEATER i
ROOM/SPACE HEATER 1 i
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER _Z__ •
WATER HEATER i �,9 L %
OTHER 'F ,
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAG BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ( 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. I
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT j
zi, 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 I
`- and that all plumbing work and installations performed under the permit issued for this application will be in compliance ' I Pertinent provisi f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Gip — ., 51-er...-�,_,,.� LICENSE#a09-2/ SIGNATURE
MP ❑ MGF❑ JP R<GF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP❑# LLC El# 1
COMPANY NAME ADDRESS ?O uV-6 .-S �oI/i Pd'
CITY //CC'',a i L L----- STATE �// ZIP TEL 2 1/.,.- ?.Ci5-O9/O
FAX CELL EMAIL
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑•
❑
FEE: $ PERMIT ft
PLAN REVIEW NOTES
•
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APPLICATION FOR PERMIT E C
City or Town: Yarmouthr
3
Date: 04/20/2018 r s
Permit Number: 102244
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: South Yarmouth, MA 02664
For permission to: Unvented Gas Heater Installation 527CMR 1.12.8.6
Name of Competent Operator: New England Plumbing services/Paula Trs Cert. No.
Date Issued-Rejected 04/20/2018 By
(Signature of applicant)
Date of Expiration: Fee: $50.00 $ Paid Due
139
11 MI01
vay
zip=fBepadfinkfill l ,Y &viz& — , t k, Alat2, `r)'lamibae
0 .61. e. 10 25, ,�Lal./ aaf Mow-, `I�A. 01775 0 p .
PERMIT
DIG SAFE NUMBER
City or Town: Yarmouth
Date: 04/20/2018
Start Date:
Permit Number(if applicable) 102244
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: New England Plumbing services/ Paula Trs
For permission to: Unvented Gas Heater Installation 527CMR 1.12.8.6
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
At: South Yarmouth, MA 02664
Fee Paid $ $50.00 This permit will expire on
Signature of Official Granting Permit Title C 1�T• gU c
This permit must be conspicuously posted upon the premises
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