The URL can be used to link to this page

Home My WebLink AboutBLDG-23-000387 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE (July 25,2022 'PERMIT# BLDG-23-000387 If JOBSITE ADDRESS 96 POMPANO RD OWNER'S NAME STOCK DAVID K G OWNER ADDRESS STOCK PATRICIA T 20 VENTURA ST DORCHESTER CENTER MA 02124-5804 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 NO El 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER OF INDEMNITY CI 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 lomejussila LICENSE# 31971 SIGNATURE MP❑MGF 0 JP El JGF❑ LPG! El CORPORATION❑# PARTNERSHIP ❑HI ILLC❑# COMPANY NAME: ADDRESS. 84 Boo Lane, CITY WEST HARWICH STATE MA ZIP 02645 TEL FAX CELL 5087768943 EMAIL lomeiussila(ahotmail.com ate' w S310N M2IARI NVld #1IV d3d $:33d 111412l3d 3H1 SV S3AU3S NOLLVOIlddV SIHl o N saA S310N NOI103dSNI 1VNId AlNO 3Sfl a0103dSNI 2iOd 3OVd SIHL S31ON NOI103dSNI SVO HOflO i -AN. Ii.r �-'- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK --X-r:%.WI y - /4 MA DAT "7-t) 3-----c: ')..E PERMITZ3 JOBSITE ADDRESS 01 OWNER'S NAME c G OWNER ADDRESS C • JOY'• �T,/ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: ❑ RENOVATION. REPLACEMENT: ❑ PLANS SUBMI TTED: YES ❑ NO 1 APPLIANCES -1 FLOORS—I BSM 1 ? 3 4 5 6 7 0 9 10 '11 12 •13 1 BOILER BOOSTER CONVERSION BURNER — COOKSTOVE / �— DIRECT VENT HEATER DRYER I i FIREPLACE FRYC)LATOR FURNACE GENERATOR GRILLE — (TI _� INFRARED HEATER LABORATORY COCKS I i MAKEUP AIR UNIT L •A 22 1 OVEN - POOL HEATER J �ulLpiN�; t�E a�Tnn_NT ROOM ! SPACE HEATER r ROOF TOP UNIT TEST _. . UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER 1 OTHER } INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YEN NO ❑ I IF YOU CHECKED YES , PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X OTHER TYPE INDEMNITY ❑ BOND ❑ I 1 • OWNER'S INSURANGE WAIVER: I am aware that the Licensee does not have the insurance coverage required by Chapter 142 of the j 1 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 a• I accurate to - e b:,�t of my knowledge - - and that all plumbing work and installations performed under the permit issued for this application will be in comp ': ce 1",'yin :provision of the itti Massachusetts State Plumbing Code and Chapter 14 of tile? General Laws. 31911 PLUMBER-GASFITTER, NAME/`orhe. WSr c, LI CENSE # i / / SIGNATURE MP ❑ MGF ❑ JP JGF ❑ LP ,I ❑ C RPC) ,ATION 0 li P RTNERSHIP ■ #r LLC 0 it COMPAI Y NAME7 ellinik,aot: $ e4''/,/lO cb / ' AL�GREST, S Of //et. CITY Po%rw i rip, 'J STATE VA ZIP 0 e/ T FAX CELL — 776 -0�Y.3 EMAIL C%/0) Mith7e/ , Co'1/)1 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 1