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Home My WebLink AboutBLDG-23-003184 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY [ARMOUTH MA DATE December 08,202. PERMIT# BLDG-23-003184 JOBSITE ADDRESS 146 CRANBERRY LN OWNER'S NAME NELSON CHRISTINE G OWNER ADDRESS KIBBE MARK R 146 CRANBERRY LN SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 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 ❑ 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 LICENSE# 34056 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION 0 # PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [THEO PLUMBING AND HEATING LLC ADDRESS. P.O.Box 397,P.O.Box 397 CITY Centerville STATE MA ZIP 02632 TEL FAX CELL EMAIL theoplurnbinq(a,yahoo.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 -' -r",t7' -CITY--- J- (S0''4) MA DATE (Z.I / fozz- PERMIT# C c ?CAM A D SS Ikl\ ( C‘t4h�iP/.1) t'..wh,e_ OWNERS NAME f a/VC r..b Le ay _ G C[ 41FN S � D _SS t, TEL 5 o 76 -;,3 c-7 FAX TIT 0 TYPE COMMERCIAL❑ EDUCATIONAL PRINTElRESIDENTIAL CLEARLY NEW:D RENOVATION: ❑ REPLACEMENT: D PLANS SUBMITTED: YES❑ NO❑ APPLI.ANCES 1 FLOORS-I BSM 1 2 3 4 5 6 7 " 9 10 11 12 13 1'I BOILER -----1 BOOSTER CONVERSION BURNER COOK STOVE — ' DIRECT VENT HEATER 7-1 DRYER I FIREPLACE i FRYOLATOR ' FURNACE GENERATOR - GRILLE INFRARED HEATER --j LABORATORY COCKS i MAKEUP AIR UNIT I 1 OVEN POOL HEATER ROOM I SPACE HEATER ' ROOF TOP UNIT TEST - . UNIT HEATER L-- ' UNVENTED ROOM HEATER WATER HEATER OTHER i I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑v' NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING ThIE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY e 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-• 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.Li j ' PLUMBER-GASFITTER NAME N.c1'16kS Ti.)«h^r`11415- LICENSE# 3'0 56-T SIGNATURE- _--- MP ❑ MGF❑ JP Ig JGF❑ LPGI ❑ CORPORATION ❑# 'PARTNERSHIP❑�I LLC El T� COMPANY NAME lto 16)�^�1,^, a� aaf,`', D ADDRESS V •d &DK 35') CITY CQ'e✓✓,1\C / STATE/ &' '- ZIP 37G E TEL )iN / 1 G ?3,(2 FAX CELL EMAIL T.Vt() flJrn'0I,-<IA �06 . ( 0�1 ROUGH GAS INSPECTION NorrEs, THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT l I J FEE: $ PERMIT # PLAN REVIEW NOTES