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Home My WebLink AboutBLDG-23-006038 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK et CITY EARMOUTH MA DATE May 02,2023 PERMIT# BLDG-23-006038 t_f= JOBSITE ADDRESS 345 HIGHBANK RD OWNER'S NAME BORDEAU JAMES C G OWNER ADDRESS BORDEAU N E&MOLINA J 19 DEER RUN RD MERIDEN CT 06451-4918 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 I 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 E] 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 Caleb Maddeford LICENSE# 35506 SIGNATURE MP❑ MGF ❑ JP El JGF❑ LPGI ❑ CORPORATION❑ # PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [ ADDRESS. CITY STATE ZIP TEL FAX ]CELL EMAIL cmadd19(cD,gmail.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 I ASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING r� 7s �-- WORK' CITY (�� ; U MA DATE PERMIT# LLD 6 . 7-3 JOBSITE ADDRESS �Lr5j �`r� ,nY� c OWNER'S NAME VGl G OWNER ADDRESS 5t6 0 i ` � �Y1� `�6 TEL FAX TYPE OR OCCUPANCY TYPE .,IAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ APPLIANCES 1 FLOORS-4 BSM 1 2PLANS SUBMITTED; YES 11 NO DI 3 1 5 6 7 8 9 10 11 12 13 1, BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - DRYER FIREPLACE FRYOLATOR FURNACE - GENERATOR GRILLE • INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVENIII POOL HEATER - ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER —__1 WATER HEATER OTHER Min all I have INSURANCE COVERAGE a current Itabiii insurance policy or its substantial eq alent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 La s,and that my sic nature on this permit application waives this requirement. • SIGNATURE WN R OR AGENT CHECK ONE ONLY: OWNER AGENT ❑ "s c4, 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 plumbingwork pp p eand installations performed ofun the her the permit issued for this application will be in compliance 'th all Pertinent provision of the LEI Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER I\IAM CC..,Are lCAC2k. e c 'C Cl LICENSE# (A, 35 G- SIGNATUR MP D MGF❑ JP JGF� r ❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC2i COMPANY NAME NC.."."(\\ ''t-cti ' \VyY1)9-1Nii ADDRESS 53 U\}t`yNelC nh Z 1S\ CITY 0 DT.30841 STATE 4::)' ZIP C..5D, k3 TEL l'74 "ifG LI t{7y FAX CELL EMAIL Cm C-i CC\81(11044.4\ •COPY) • IdOUGI3 GAS IrfSPECTION N0T'ES THIS PACE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • • • FEE: r PERMIT# PLAN REVIEW NOTES • • • •