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Home My WebLink AboutBLDG-21-002995 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY [ RMOUTH MA DATE November 25,202( PERMIT# BLDG-21-002995 tom✓ a JOBSITE ADDRESS 624 ROUTE 28 OWNER'S NAME ANGELIQUE YOUNG ERI TR G OWNER ADDRESS ICHIBAN REALTY TRUST 6 BRIGATINE PASSAGE DR BUZZARDS BAY MA TEL 02532-2230 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ELPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY Dennis Port STATE MA ZIP 02639 TEL FAX ]CELL EMAIL office(c�3gsplumbinq.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NoTESN, Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE:$ PERMIT# PLAN REVIEW NOTES /VW 4 V4 K Uti; 1,-,• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK T.�.tl �=ii a ti xv CITY Ii_" n z/ JMADATEL, kJPERMIT #Pf.20_,6- •c�/-0 2 995 A - } rtcntxacnc'r aster•-•.«• +. JOBSITE ADDRESS,, _ .. Q ,r 1 OWNER'S NAME {,z� c . Gl OWNER ADDRESSL.1thezi..,frfr. -1 TE'�---�-- ^ 3 _______ 1/1.:VialFAX TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL 0 RESIDENTIAL EV PRINT CLEARLY iNIEW:LI RENOVATION: L.1 REPLACEMENT: LY PLANS SUBMITTED: YESJ NOE APPLIANCES 1 FLOORS-) BSM 1 111311 3 4 Km 6 7 r 8 9 10 11 i2 13 14 BOILER Ini , . _ ` a.� 9 � �� ._.. r�.ar - ._. .�. , BOOSTER : �,A� ' • I t �,CONVERSION BURNER _ ir_., i _ - _- ,j _ ii. i _ r COOK STOVE - _ ... _.;U pM ' M._ - DIRECT VENT HEATER ,� if_ _ - y l i DRYER -;(( r - __ - IMI-Ft 3 - r 1 - FIREPLACE ...__ - — - - - - r, t t FRYOLATOR Mit [ ;, ,; FURNACE :; � ' - - ' -.__- -.-_---- -_ I`_ -1}tr�+sxE , Apr l�(llL. , L. '_ alit` _Fr a GENERATOR xsrrir.. .,�. . _ _ ` °., T.�7�_ �� .. . F �. r. _ __ GRILLE . I _... ., , I r fill �,� a�raa, 't{ t INFRARED HEATER7"-.17i - . li �' _� =..'•.rare, •.=--r... ;i - y_; . � -r c r:..r t r -1• .rir- .e •.-.x ' .L.3u:®�s12.:�1"� -^__.__..... �._.... . 1.a�S92t.. . . �lili! '3'�,r. _ r _ `I�(�'1 :�'Fv� •+W bpi , �Y_'�.��: LABORATORY COCKS i'- .I _'' - . r 1 t ,,.,.r...r.r•,r• .r..�..r�w. -e _� yr_..--' 4.';.'-a!"'_._.- - - `-- - _r _!Mil i MAKEUP AIR UNIT ` 11001110011111111 POOL NEATER __. . _______ _ • �• i I ROOM/ SPACE HEATER I' 7 I `' t : ,. ,ter:. : _ __ — ,' -�- , i.---i, _ --„ ,,,�_I1•.. :—• ROOF TOP UNIT 1' 1 1 czt. in TEST ••i :.. :.,� ..,,.I . I'= tt r fL_. _ , _.Ya �:�'.,. i � -=w.�r• •. - ---,v _ ..-yeti Gi _ _l•. � ma ..._.._ ._.� , UNIT HEATER _ ! , ;1 -11rt i,...11 cE UNVENTED ROOM HEATER li �t --1.-_, .-_,v n,. ..v,.:�..,r_As. yiiiki 11[11_1A.r.) WATER HEATER - r. OTHER ' .._. ... .Ii _ _ ._._.-_ — 1 __ lr ___ __ i • 1 .......... .._ _. , . . , _ _ MMilaigamillonlilimiillowillaw. Allilimili ----i . _ , ._ _ . ._ _ __, _ , _ _ _ __________..._ ___ _ .,., _-- ..-.._---.r.,..,.r.....w.�.wr..nar.rra...,..w,a...,s;�+:a,rcw wz...r ,•.i •i►1111 amt�. - +• .w. ' /�° `__"�._---r� .l e:e,�.,. ..:a._•r.vmrw:i.iurriaa-..��y_..vau...:.•.-......._y.r.;c:Fr...rar'YtiY.` . i +-.�... -. '.�r. .. .. _ .. ..._.. .. ... rsri,r. a. +s n.cr,-rwe .,.-.•,r. rt r+r•—,r.,ra ,r.C':sow .. :.-rt,..,,., INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES lij NO Ej I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW' i ., 15 - D ' LIABILITY INSURANCE POLICY Eli' OTHER TYPE INDEMNITY [j BOND 0 9 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coveragerequired byha ter1142 qP thee. Massachusetts General Laws, and that my signature on this permit application waives this requirement. ._ . J BUILDING UEF-iRT-iv.ENT CHECK ONE ONL J3y: „. ,3'-,_.'s r r f._ g"'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 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. /-9,41/ (4P PLUMBER-GASFITTER NAME 4 �- `• ". 6) t�`�V LICENSE # ? SIGNATj E _. --= MP al MGF El JP El JGF L, LPG!® CORPORATION ID U-4 v G PARTNERSHIP[�L.]#L_ �__r„� LLC( 1#L.r� �- __ _— COMPANY NAME' `� -,1A.), -- -- , ADDRESS !TY 1 %; r . CITY P ?wl _,._ STATE1, ,,,,diZIP - ,, ' �TEL �f 2 - ' 7 -vaJiNeJ�.�Y95Wi'!Yilt,C►.ri`nb i-"- >•tiiia®isYOA4Y4 i 7 /IiW>ma��.11itl LGi�N1 FAX -3?t -b d CELL - �.�..., � EMAIL ,� 1 C L 4 7 �,5 ii.r •`'.,.. �' .ar >� arts�mr+aer� ? � � � ,,.L -,.�1,,,.ri•, •.sr_ ..yu.r --,..�ao•.+-�vm•