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HomeMy WebLinkAboutBLDG-23-005700 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 4s CITY YARMOUTH MA DATE April 13,2023 PERMIT# BLDG-23-005700 .,, JOBSITE ADDRESS 27 MCGEE ST OWNERS NAME MORAN JUDITH HELEN G OWNER ADDRESS 27 MCGEE ST WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:D 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 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 1 OTHER DESCRIPTION:pipirg for meter 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 INCEMNITY❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have tie 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 plumping 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 Charles Markarian LICENSE# 9197 SIGNATURE MP❑ MGF © JP❑ JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: f-IE PIPE DOCTOR ADDRESS. Po Box 2227, CITY Hyannis STATE MA ZIP 02601 TEL 5087756670 FAX ]CELL EMAIL cmurphy .plumberscapecod.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 `• ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: Yarouth MA. DATE: 4/11/23 PERMIT#{ 1 2 ZI�P1BS E ADDRESS: 27 McGee St.W.Yarmouth OWNER'S NAME: a 14-15 PA R PVC ADDRESS: PO Box 2227,Hyannis,MA 02601 TEL: 508 775 6670 Fes:, 8 TYPE PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑x CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT: x❑ PLANS SUBMITTED: YES 0 NO APPLIANCES FLOOR Bsmt 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 FRYOIATOR FURNACE GENERATOR GRILLE kij INFRARED HEATER j LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER \} ROOF TOP UNIT fi TEST UNIT HEATER 4.1 UNVENTED ROOM HEATER WATER HEATER I I Gas Piping for new meter x I I I I I I I I I I 1 1 INSURANCE COVERAGE I have a current Debility insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ® NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POUCY © OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee km 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. � u- / 2G4`��GMt��y T CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF(NER OR ;EN 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. /)/L� PLUMBER/GASFITTER NAME: Charles hMarkarian LICENSE# 9197 ( �/ SIGNATURE COMPANY NAME: The Pipe Doctor _ADDRESS: PO Box 2227 CITY: Hyannis STATE: MA ZIP: 02601 FAX: TEL: 508-775-5670 CELL: EMAIL: cmurphy@plumberscapecod.com MASTER E JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0# PARTNERSHIP❑# LLC❑# E tri/9/L. ADD2eSS : cmurphy@plumberscapecod.com - _.. i .rip „1 ..a'.. ._ Sr, 4 ;Ar, t .. .. ...... .. ... i 1, '74, Ri •4 e • -.. - t �':