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HomeMy WebLinkAboutBLDG-21-000705 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE August 13,2020 (PERMIT# BLDG-21-000705 JOBSITE ADDRESS 10 LILAC LN OWNERS NAME MAXWELL RICHARD B G OWNER ADDRESS MAXWELL LEILA R 10 LILAC LN YARMOUTH PORT MA 02675-1559 TEL L TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES❑ NO 0 FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 ❑ 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 Ralph Giangregorio LICENSE# 9339 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: RALPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY Dennis Port STATE MA ZIP 02639 TEL FAX CELL 1 EMAIL offce(a!3gsplumbing.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES /-l F fr/ — 1 I// 1 L'�L--- r:4 \-.tl ?:I; edG€� _- 3 TJAWORIE APPLICATION EOR A?MINT IIfln TO PERFORM ME s oTYLAiO WORK JOB I EADDRESS ! :e L _ :` OWNER'S iNME 1 •IC 'KO ►2.E11 (l r - , ..17 OWNER ADOgEsS:1 ,.,"A/4-1 L-- — tong OP,. OGGUI'Al~IGYiYPI= COME:Mt❑ BDUCATIONA4r RESIDEMTI4Lg CLlr SLIZ NEM Dl RE7,1QS ATIOl:1 i P,EPCAACBIEN'T;0 ' PLANS SUSI0 lj t E : YESD ND 0 l=inUTRE8 I FLOOR— 1 Ssrni I `71:777-4 1 5 1 5 . I T i S n 1 ID i ; 12 i 13 1 4 BOILER I = '8OOS i R I I I I ' 1 I 1 1- 1 CONVERSION DUI »ER e. - - E I I I 1 I I I I I COOK STOVE, I 1 1 1 {1 (`- 1 1 1 1 1 I I Oti G='VENTHEATER l 1 •C 1 ! I 1 i —1 t�RYa j i I I FIREPLACE C • I I 1 I 1 I C 1 I r'JRA :OP 1 1 1 I 1 l I I j I I FURNACE- 1 1 1 T 1---MO ))I �1 t N�ATOP ij (1 1 ( 1 (�::51i.Iao1 I 1 ;. 5oRaTORYOW I 1 1 1 f 1 - 1 I I I 1 tcialP AIR ir~lt T 1 l 1 1 I. I 1 I - OVEN 1 I I I 1 l�l 1 1 POOL,HEATER 1 I I ! I I 1 i C S F l ROOMi SPACE Her 1 i 1 1 i ' 1 ROT!TOP UNIT - I 1 i I i •I 1 • 1 iE�1 I I I 1 1 UNrHEArei, I I I 1 I I• i ` - Ul!\iE.i►T O ROOM aIE -I I I C I t 1 r 1 1 1 V'A_T i inTEI' 1 l 1 1 • 1 I- 1 7:q k. 1 I I - I • 1 I I I 41 1 I I I C 1 C 1 . 1 1 I 1 I 1 1 ) 1 1 I MJ URICE COVERAGE 0 I Nava cuc ni liabilirvinsare.ncepolic arils sftU t a alan< icitreas Me as I of NM-C11 _E ND I you nave c{h;:cic ..plasegindite rasiyps o`r cover-malty chef:111g the appm:I:iatebait beim • UP. [LTikrI11ISUR Jl10EPOLICVl II'" OTHER TYPE IND MET u BOND 0 ' - OIh P E1?'S IiL1111111iCE LIVAItJER:I am aea Thal I-B UM-rsa~doe nat ave/ba►' ► e cmrai-a•ragth d by CileptE 42 of thG - Ma s tusetiz Gem al a' and that m y signe'ons an this 13aimlt application vt. i this rm.:pentrant • CEECIC ODIC ONLY: OO111111,R Q1 AGEI1T 0 801/41.119E-OF ViSWRS',ORAGENT -_ hereby certify that ell of isle delalls anti iniomidon I have suarmiad[or antarse4 rasing tie aoplirdon are tie and accurate to the be:g my Kitmledge Ind them pits t3lgwwi d lniialleiions primed unde ine pentrlssuad for ibis appllcadon villl ha in compliance with all Perlinen} pmt.telon Idle ivitneousem Ste Plumbing Code and Chaptef 1 2of the General Laws. PLUMBCi'`�(ralBF1Tr!'NAiu1ti; 16 =7 L r.14;vGigc-oreagALICEEEo SiG! MI RE COMPANY MtulT.:1 C`�S A:.AI e,�vs_ fr/-• - / G I ADDRESS:i1 _thU ,1 e . 1 CITY: f I •j1 iA Jr: D G� , ;;ale .5Vo—IP VS , ITIL 5 19- ._ , CELL: 22J C 2!7AIL _1 3415 PiUf�h��c ,l LI.C�, AMR CFI l JQIdP,rlf�1`NI 0 LP I4� T.AU MM GQRPOR AID 2c7 �tL P 1 M ERSHIP 9 i _l: _ ' ,