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HomeMy WebLinkAboutBLDG-22-000395 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK IL�i CITY YARMOUTH MA DATE July 21,2021 PERMIT# BLDG-22-000395 ,47 JOBSITE ADDRESS 47 HARBOR RD OWNER'S NAME DOYLE MICHAEL J G OWNER ADDRESS DOYLE J M&DOYLE B M&J C 11 HADLEY COURT ARLINGTON MA 02474-3810 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 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❑ 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 Daniel Asquino LICENSE# 19715 SIGNATURE MP 0 MGF 0 JP© JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: DANIEL M ASQUINO ADDRESS. 205 ISLAND POND RD, CITY PLYMOUTH STATE MA ZIP 023601592 TEL FAX CELL EMAIL danasquinoRgmail.com S310N M3IA3?J NVId #JI1Al2J3d $ 333 ❑ ❑ 111Al2J3d 3H1 SV S3T213S NOI1VOIlddV SIH1 oN saA S31ON NO1103dSNI 1VNIH AINO 3Sfl H0103dSNI 21Od 3OVd SIH1 S31ON NO1103dSNI SVO HOf1OH . t__ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK boa •y _ ;71: t_ter CITY lI G. /'r-►�e,r -� MA DATE 7— ?.. 1 .- a 1 PERMIT * Ufa 6- 2-Z- 00039 Jr rc; I y W JJOBSITE ADDRESS LI 7 ` c.f b uf_ e OWNER'S NAME DO \) If �" _ —� . OWNER ADDRESS TEL~ t TEL FAX LU Q 0 1'PEc OCCUPANCY TYPE I. COMMERCIAL (� EDUCATION ❑ RESIDENTIAL W E F 1 ' ` NEW: ICe f�EIJOi�ATIC�I�I: R- PLANS SUBMITTED: ,� i� EPLA�EMEN I. U YES (❑ NO ❑ mm !Mf'�I>"�\ICEL FLOORS-� BSIO 1 2 3 4 5 6 7 8 9 10 '1.1 12 13 1 BOILER BOOSTER CONVERSION BURNER ` COOK STOVE / DIRECT VENT HEATER DRYER FIREPLACE I FRYOLATOR FURNACE GENERATOR GRILLE - INFRARED HEATER LABORATORY COCKS 1— i • MAKEUP AIR UNIT 1 OVEN i POOL HEATER 1 ROOM ; SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IVIGL. Ch. 142 YES © NO fl 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY IUISURANCE POLICY yOTHER TYPE INDEMNITY 7 BOND I • OWNER'S INSURANCE WAIVER: I ani aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER f l AGENT n •-, 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 complianc Ft. Ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 ` tt� PLUMBER-GASFITTER NAME 041 l'( I S kS)%•)"‘) LICENSE # ( 57i c SIGNATURE MP ❑ MGF 7 JP , , JGF ❑ LPG' [ CORPORATION ❑ It PARTNERSHIP D it LLC ❑ # S.— j y COCOMPANYI�NAMEh � S p v/'' 0 '' i ADDRESS )-0 S iS I � s P�v CITY PiAt -.4 ` STATE l'^ a(4 ZIP 0 ? J TEL FAX CELL Sli- '.3 7- ° EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT tt PLAN REVIEW NOTES