HomeMy WebLinkAboutBLDG-23-005528 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
,_,(s CITY FARMOUTH MA DATE April 05,2023 PERMIT# BLDG-23-005528
JOBSITE ADDRESS 332 PINE ST OWNER'S NAME ZAPPULLA FRANK E
G OWNER ADDRESS ZAPPULLA MARY ELLEN 3 CARMEN CIR MEDFIELD MA 02052 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ 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 1
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 0 OTHER OF INDEMNITY 0 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 Dennis Gagne LICENSE# 9804 SIGNATURE
MP 0 MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑#
COMPANY NAME: EENNIS M GAGNE ADDRESS. 31 Cherrywood Ln,
CITY Marstons Mills STATE MA ZIP 026481761 TEL
FAX CELL EMAIL oagnepmd51(Oaol.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
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
;7171;fi1 CITY d/�,,ne L Q/ MA DATE 4/--..9-OF PERMIT# Z 3- S Zd
JO ITE ADDRESS ?Z J- ST" OWNER'S NAME
GOWNER ADDRESS r7iX efj2s7t4.- . TEL FAX
TYPE OT TYPE COMMERCIAL ED CATI EDUCATIONAL
PRINT OCCUPANCY ❑ U 0 ❑ RESIDENTIAL®�
CLEARLY NEW:❑ RENOVATION:[:]REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
APPLIANCES Z 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
y GENERATOR _
GRILLE _
INFRARED HEATER
+LABORATORY COCKS
MAKEUP AIR UNIT
t
OVEN
POOL HEATER _ _
ROOM I SPACE HEATER
+
ROOF TOP UNIT
TEST
UNIT HEATER _ _
UNVENTED ROOM HEATER
WATER HEATER _
OTHER ,
. Jo6- ( -
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES --- 0❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY[Zi.------ OTHER TYPE 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.
CHECK ONE ONLY: OWNER❑ AGENT ❑
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 P` elt►nent 'rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r
. „.77.;
PLUMBER-GASFITTER NAME ,�(7/lrli`s f� � !•!�p LICENSE# ‘I57c SIG A 1
MP ' MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION 3::2 3,' PARTNERSHIP❑# LLC❑ #
COMPANY NAME: ,f,49,,,,,1 p�j`,r i ADDRESS // ///fr' 7
CITY a.///edlt6ii( STATE,/ A, ZIP f TEL '77�/-,Y3 G"]1-e(
FAX CELL EMAIL Gz4/Adfoie-57. r2 C1G/ ,'i