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HomeMy WebLinkAboutBLDG-23-004932 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ia.'' CITY YARMOUTH MA DATE March08,2023 PERMIT# BLDG-23-004932 Jf � JOBSITE ADDRESS 941 ROUTE 28 OWNER'S NAME BRANDER STEVEN P TR G OWNER ADDRESS AL-JAY REALTY TRUST P 0 BOX 590 SOUTH YARMOUTH MA 02664-0590 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL J❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO El FIXTURES FLOORS— BSM 1 _ 2 3 4 5 6 7 i 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE _DIRECT VENT HEATER 1 DRYER FIREPLACE FRYOLATOR FURNACE • 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 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 ❑ 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 Chris Poire I LICENSE# 133091 SIGNATURE MP 0 MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME (Poire Plumbing Heatq&Cooling ADDRESS. 51 St.Joseph Street, CITY Hyannis !STATE MA ZIP 0261-0000 TEL 17748366461 FAX I !CELL! !EMAIL Imcplumber26Wgmail.com .r 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 R E t V EASACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTI NG WORK J ¶ Q J `''1 MA DATE PER # 2 3` d�7 9 -' i JOBSITE,ADiRESS • I i �I {, a - ,3uII G DE-'ARTMENT QQ` I OWNER'S NAME 1-/ Tgl� �� _'ir IF -_--._valA IJFR A r'RESS TEL FAX TYPE OR OCCUPANCY TYPE COMME ,IAL❑ E EDUCATIONAL D RESIDENTIAL❑YET CLEARLY NEW:❑ RENOVATION: REPLACEMENT:,/ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 BOILER 9 10 11 12 1, 1h BOOSTER - _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABUPJATORY COCKS MAKEUP AIR UNIT OVEN — POOL HEATER - _� • ROOM I SPACE HEATER ROOF TOP UNIT TEST —±-2 UNIT HEATER " • UNVENTED ROOK! HEATER - _ �— WATER HEATER OTHER INSURANCE COVERAGE r I have a current Iiabili 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 COVE E BY CHECKING THE APPROPRIATE BOX BELOW 7 LIABILITY SURANCE POLICY OTHER E INDEMNITY I:: BOND • 0 E 'S INS ICE WAIV R: l m aware that the licensee does ave the insurance coverage required by Chapter 142 of the M sa r used eneral a and that my signature on this nit application waives this requirement. SIGNATU F OWNER OR AGENTCHECK ONE ONLY: OWNER ❑AGp� ❑- -• I he by rtify that all of the details and information I have submitted or entered regarding this application are true a a urate o the bes my knowledge `s- and tha all plumbing work and installations performed under the'"` Massachusetts State Plumbing Code and Chapter 142 of the General Laws.it Ed for this application will be in complia wilt)all ertinent rov' ion of the 'L1N PLUMBER-GASFITTER NAME at ---5 Q I LICENSE# L j 3 Q S GNAT .E MP ❑ MGF❑ JP Ig-vjGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME S-70.� p ktc, ADDRESS �� 5'N k- n ` CITY C J or STATE ZIP 6 CO� CO + TEL EL FAX CELL 77 LI g ) c c(fc( EMAIL (---" v r UGH GAS Tl�ar�N0TES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT fI PLAN REVIEW NOTES