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Home My WebLink AboutBLDG-21-003666 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '''-474i -; CITY YARMOUTH MA DATE January 04,2021 PERMIT# BLDG-21-003666 JOBSITE ADDRESS 334 ROUTE 6A OWNERS NAME PAINO MARY C G OWNER ADDRESS 334 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 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 I SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: t 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 Anson Celin LICENSE# 32655 SIGNATURE MP 0 MGF ❑ JP❑ JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: ANSON CELIN ADDRESS. 26 Capt.Blount Rd, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL ansoncelin@yahoo.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTE Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES 1 1 MASSACHUSETTS UNIFO I'� 'APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �_I_I_ CITY �cAt rmc.,11'Ll 67U'd' r I MA DATE ]Z--I -' PERMIT# Zl-cam � Ir1. _ �'.� -{OWNER'S NAME fJ j JOBSITE ADDRESS' _I i 'i_ l "�tir� 1,v1�t"�kI OWNER ADDRESS �J '1 \.- ("� {� (TEL - 9 i -3- J �.AX i TYPE OR OCCUPANCY TYPE COMMERCI EDUCATIONAL J RESIDENTIAL`. PRINT CLEARLY NEW:;LI RENOVATION:;Li R:i' •'dEMENT:_I PLANS SUBMITTED: YES;,_I NO APPLIANCES 1. FLOORS-0 BSM 1 1 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _J i 1 • ___ I'.__J___I__J_—J __.I__J—1 BOOSTER —1 I ' I. I , _—I— '—J____/_I_ 1 __I_1—J CONVERSION BURNER I I I I 1 ! I I, I 1_1_____1_I'__I___1___1- COOK STOVE I l r I I_ —J—_J—J:�—J —I _—I DIRECT VENT HEATER ._ kl�_J. I—J—J _ —1 _. -I—J��_� DRYER- I .. I I _.. , —� . I ___1_;_-___1: _1 —I I—_I I—J FIREPLACE --_-_I- ---_I 'I' —J_I__.-_J I I� 1- 1 -_-___I-_ —a—J I FRYOLATOR I I 1 I �I .... _ I _1 I _ I I-- I —1 I _ J 0 FURNACE I t I_ I I I I - _I --'----1 .____1 I I GENERATOR i_ .. I I I _ -..' 1---- I—1 I ' I GRILLE __I•_ 1 I I _ d�J'_.1_ 1_I_1.__1 —J I INFRARED HEATER _1_1 , I. I _;____I —_____1 _J J_1_ _J 1 LABORATORY COCKS I. 1 , , 1,_____I I 1__.1_ __I—.__I—_J____1_1_,_-1_1 itMAKEUP AIR UNIT I_ J _ I I 1_-_i J I _i_._I__i:___i kOVEN I -_I I __ I I .____i I .__._I __J______1____i I POOL HEATER ____I— I II i_—i _ I I , ' I_..1 _..__1 I_�I___J_._I ROOM/SPACE HEATER 1 1 I ' ; - I I - 1- ri I I I ROOF TOP UNIT l _ '�`�, l i _-.--..1 I I 1_I _ TEST I ' ' t ._ _I i�I i I I.- - I I UNIT HEATER 'IIr t— 1 __..; I i i 1 UNVENTED ROOM HEATER _I_1_ i L1-1 1 i __ _1 1__J_____i ;_J _1__1 WATER HEATER I OTHER , I_ I 1 I I I . I I.._ . I _-J I_J I —J. ' • i I III 1 I I_-__i_____I___1 . 1 I —_ 1 —I'__J _J —_J 1-_I -_I 1 1-i_J Li — , - I _ I I_j=-I— _—(—_I . - ; I 1 ! I 1 1 I. t SUFANCE COVERAGE I have a current liability insurance policy or its substantial quivalent which meets the requirements of MGL.Ch.142 YES I NO ;J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE- GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY -Y-' 11 OTHER TYPE INDEMNITY .i BOND Li OWNER'S INSURANCE WAIVER:I am aware that the license dre!not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this •ermrt application waives this requirement. CHECK ONE ONLY: OWNER :T--II AGENT Li SIGNATURE OF OWNER OR AGENT 1 I hereby certify that all of the details and information I have submitt'd 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 pe it,Issued for this application will be in compliance with all Perti ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the Gene CI aws. /a Y_._..___.-.. _ v. (1 '�s __ PLUMBER-GASFITTER NAME; Url .'l 1 1 1 _1 LICENSE#3&S i SIGNATURE -- �. 7 f L / _ MP MGF aJ JP� JGF' LPGI CORPO TIeN i#y PARTNERSHIP # I LC:_[#:— I COMPANY NAME: S„ ,i Cr.I1,� A r;DRESS �� C�l ed—li i ti- (�)I C•,if;i— J t,(� 11 CITY ''l.:,t 1jUYI'hC v1 .. .. - I- E i�'1 I ZIP C L ( c TEL bi-ZI-tO -Z-/4�- 1� FAX ( CELL 'EMAIL -\r I _ ' `t• Lti{.00. 6,'M 1 1II 1II CA(110 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 • I • • • • r► .