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HomeMy WebLinkAboutBLDG-21-000640 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE August 11,2020 WERMIT# BLDG-21-000640 JOBSITE ADDRESS 1229 GREAT WESTERN RD OWNER'S NAME LAYVA JOSE G OWNER ADDRESS C/O JOSE LEYVA 229 GREAT WESTERN ROAD SOUTH YARMOUTH MA 02664 tELI TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 _ 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 1 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 I Ralph Giangregorio _ICENSE# 9339 SIGNATURE MP©MGF❑JP❑ JGF LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: RALPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY 'Dennis Port STATE MA rIP 02639 TEL FAX FELL _MAIL office@3gsplumbing.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes N THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ .'G�/Zo /?/&,1› 4' FEE: $ PERMIT# PLAN REVIEW NOTES " P� fuo 97 iv i -y ; ij 4 g GE L _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ==115.---re CITY ii--N do MA DATEL...--.,. 1PERMIT# , y v -- a M JOBSITE ADDRESS lr a 6.40 OWNER'S NAME 6. - -Lig.,-a..)--= OWNER ADDRESS f " �.k _ ____.1 TE -77 ter_ AX TYPE OR 4-41 PRINT OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL, CLEARLY NEW: RENOVATION:El REPLACEMENT: r PLANS SUBMITTED: YES . NOEir APPLIANCES 1 FLOORS-) BSA! 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - BOOSTER all - ,� �.. III! � '-.,,..�.,,-:.. ,.g"_ [7_, ' "it . -, -- -.,r, ,-- ,,,, ".- _ MMINER CONVERSION BURNER Nt ice ; - - munuom f COOK STOVE j�IBM'-- - DIRECT VENT HEATER ' M E �`_._.'_ M ..•-. �_1 ` ; .,_.� W . ...I 1 1 DRYER 'mom - -.rrtriu: _ 4f1 FIREPLACE '•° -, _. ,i!_ ti` ^._.f11 .... ___� ,,_ . FRYOLATOR -� e f i t gni_ �. .- ,ij s ~� - FURNACE r----- - - ' Ps �. �^-� v _ _.___ , _._ ".a� `� - . _�✓.- - '1.....!�s-�I .l•. GENERATOR ! GRILLE - , w INFRARED HEATER ..-_.._..__.. �_-.-- -_-. _ ,-: _ f���- ---- - -,kk��(( _ � LABORATORY COCKS - s. - - _(- ---kJ( { JU D`._ ._.� I 1 MAKEUPAIR UNIT • _ . _. _ OVEN ,10 .111111111111111111111111111.111.1111111101.1110.1.1.11,. __ _ � _ _ _ POOL HEATER , - - _I_ _ __ -. -- _ - -- _ ROOM/ SPACE HEATERiTEuI!EE ''ROOF TOP UNIT -- �).rf millilliettIMMOIN TEST f - I UNIT HEATER � --, .. �� - - = ---- _; �M1 UNIT M� ._-t.`: 1�[J ll�i l' _MI IM_.-.. I_NIONIl Cl NTED ROOM HEATER i M '�- 1�VATER H TER -� - _ ���f��. �1�� _ ��_ jam_ �� OTHER . ' r u �, N �- - E MI - E �y � _ .`''►. -'c,`i �FI !!�t� !�IIMI ll s ���. !�I 1_ .III. E'er^u! ! t Ol .fi 1 L,_,,,,, . „,iYi4Yym - . •• .-- IMAM, _I•lr.• s.-_s aj M•!�- !"� ' l U.. ... INSURANCE COVERAGE U 0 E I t imff 1 I have a current liabilityinsurance policyor its substantialequivalent A s qu valent which meets the requirements o M r, , CIi. 142 YES 0 i Pi I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA -BY CHECKING THE APPROPRIATE BOX B LOWILDING DEPARTMENT By:_._^--------- ---- LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND U 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that al!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. -? ,r J _- /4c-X.44 ----L2 PLUMBER-GASFITTER NAME,1ic __. ,R , , - nt. .,_:- . .,.. LICENSE# 3 SIGNATURE MP ] MGF 1. JP Q JGF 0 LPG' L i CORPORATION [J#J3jQç''.jPARTNERSHIPQ#J LLC DE= COMPANY NAME:1, ;; 1 ` I, b i'lc c \ ADDRESS I co- ', . I IG�t�,�� -I CITY .- �w y - . �w..—.-�.� -._ �..-__,, . ,-Qr .� 7,. :__.,___,,..___„.,.v^.. _ STATE Wi,:_IZIPIVAL-Y-LTEL j 5 6 j �---� FAX SV cq CELL EMAIL ; is -. 3-1 - i 1