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HomeMy WebLinkAboutBLDG-23-001915 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK el • .""d CITY YARMOUTH MA DATE October 11,2022 PERMIT# BLDG-23-001915 41 JOBSITE ADDRESS 15 PAULA LN OWNERS NAME SOLIMINI NICHOLAS A G OWNER ADDRESS 15 PAULA LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 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 0 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP 0 MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbridena,gmailcom 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 "- _ S- � EIA� CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK oJ� i • ' c4740 O I11,� DATE c L�L� T OG�[ PERMIT f; Z 3" � (I L JOESITE 4DD?_SS J s O,9 t11 C E3!, .lG D=Pr\R 1 Mt r3- `� /,Q OWNER'S NAME /� .'_: -1 -- SOW DDRtSS 71 TEL 6 - 5 7 / FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL ❑ CLEARLY NEW:❑ RENOVATION: 2 REPLACEMENT: XPLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS—# 6SM 1 2 3 1 5 F g BOILER 1a 12 IS 1 BOOSTER CONVERSION E3URIVEP, II 1 - COOKSTOVE - --_ N.. DIRECT VENT HEATER ■ DRYER ■ ■■■ FIREPLACE III I ■■ FRYOLATOR FURNACE �— - GENERATORill III GRILLE ■ ■ INFRARED HEATER _` LABORATORY COCKS ■ MAKEUP AIR UNIT ■ ■ ■ ■ OVEN POOL HEATER ■ ■ ROOM/SPACE HEATERI 0 ROOF TOP KNIT ■ RI TEST ® ® ■® MIN UNIT HEATER ■ UNVENTED ROOM HEATER ■ ■ ■Fil■LWATERHEATER1 , OTHER I . ElINSURANCE COVERAGE —_ - I have a current liak,iii insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES WND ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY kll 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. • SIGNATURE OF OWNER OP,AGENTCHECK ONE ONLY: OWNER ❑ 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 Staff Plumbing Code and Chapter'Id2 of the General Laws. 4 /� �/ c _ PLU A�6ER-GASFITTCR NAME LI -NSE# SIGNATURE MP ❑ MGF❑ JP L11 JGF ❑ LPGI ❑ CORPORATION❑ti PARTNERSHIP❑// LLC❑ COMPANY h ME Y " \ CA r/ tO . P HI ADDRESS 3 7 f----iG' Ike J,4 �/ ' �n� `7 CITY l , Cf 11 I 5 STATE ' Y ZIP e, �Q/ TEL 77Y1/d � FAX CELL EMAIL + ROUGH GAS INSFECTIOP4 NOTES DVS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT ft PLAN REVIEW NOTES 1