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HomeMy WebLinkAboutBLDG-21-004426 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �_ ra_ABCITY YARMOUTH MA DATE February 04,2021 PERMIT# BLDG-21-004426 JOBSITE ADDRESS 105 EILEEN ST OWNERS NAME DONOVAN ROBERT L G OWNER ADDRESS DONOVAN CINDY L 105 EILEEN ST YARMOUTH PORT MA 02675-2008 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 DIRECT VENT HEATER DRYER FIREPLACE 1 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❑ 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 Ralph Giangregorio LICENSE# 9339 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: RALPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY Dennis Port STATE MA ZIP 02639 TEL FAX CELL EMAIL office(�3gsplumbinq.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No //Zc/2/ C{j THIS APPLICATION SERVES AS THE PERMIT FEE:$ PERMIT# PLAN REVIEW NOTES filiAll i VCjEL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ._ _ CI 1,..tja.. ..1-• j�-f�.. _L'� ". 1 MA DATE PERMIT#B4)6 21 7�� JOBSITE ADDRESS ff &'f� — .. OWNER'S NAME . a, al.. .j GOWNER ADDRESS1........‘;`-- .. .2.„. TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL PST EDUCATIONAL RESIDENTIAL CLEARLY �i NEW: RENOVATION;El REPLACEMENT: El PLANS SUBMITTED: YES ED NO21 APPLIANCES 1 FLOORS-) am 1 2 3 4 5 ` 6 7 8 9 10 11 12 13 14 BOILER .- .rr..,.-nv....rr.:,r..e...rn .-.�y...a., •------T�..r�,..,.-:. ��-, ..a, �..,.. n.,...•-� BOOSTER _ 11......- �s.T. M , irfz._ - CONVERSION BURNER - '� - 1• - COOK STOVE >-_ - ,, L._._r �'r-� -'- t �{ V _if r. DIRECT VENT HEATER - j f -�..- - - --- - _-- �.�... — }+ ,_ __ "j DRYER ---- (r__' � L�._ . 4 —....._ i 1 i I FIREPLACE • ,f ,ti -. i ...... .._- �:.� - _. - , _J .- --JA FRYOLATOR t ...,.._ i • '.•r•'^--�r. .°"'••---7'- - fir 7-2:' ---••.n.. . f,.- --,- ,-' "--- kwr. -' 7.15 _v�r• I .''''-' --'''' ls..x''''' _^-'' .l.-rl 1 r'' '''' i o_r_ FURNACE .._„ -I� --� -_...__ 'i. _:--.; -at i,' - --'- ._ �=. 'I� ..,r ..11. GENERATOR = _ r __:_= -s — =y _IS ._.Li — ,. :��.�a, •. -.,_+ -- err. .n.R .� .N GRILLE -� INFRARED HEATER ,. =• f __._.. ,� _- :� � LABORATORY COCKS- iz- �.:-:.7 „ ,40-, M = ,�..„ f. •-"'*---. . .�.. F . _ :,ii, . r.IN Fa, 11 ...-.-_i f ... :. r-tna.- s za-l1-y�.. - -r.�ima ..s....n.•-�...F�'"- i a" ` ,_ :r... .a•x.r. .,.r.•.. MAKEUP AIR UNIT ., OVEN .s ' _ . . .- ... �.-. -,,,-,—* 4''''' r , r: --1 . POOL HEATER � ice- .. _ -. �.�"-"~ - = - =--- T : i t ,1 f - ROOM/SPACE H EATER .�- s•.�,-- ..� _ r.,�. -...�..-.,, - -�.. , . ..�,J,,�.t.�,-� ..�M.,,� „ ., E1 RIM _ r.,r.��'^.+ - - '+�,t' r.� l.. err: .w , ti. —_ —T f^.z- r"-•'"'` ROOF TOP UNIT , �'_,____. _ _�' _I i - �. - . ,. - ---- _ ::h.� eIrt"ri4j1r. -71 TEST I f UNITHEATER .m�, �.��•, - . „�� . -( .I -....=i1,---- -.,......---•-.I � bl -_:.2�.�,I�.,,,,., f . , fir. `�'(�ft ' n,.w.i NVEN �- s� r_I. •rx. _ -_�, *+i:'11.-..,.« ...,,,,,,-,- .�'. ,. _ .+ate __.c��CYY .r• ��"�"'_.. •� !L - a..+,>-:ua, .:r.-: U TED ROOM HEATERj__ 7, i WATER HEATER r - .� - . .._- _ _ t � - •`-�.. !..i,..-�•f•.�1`/�Y:.....1•n .�.•'n.eaai}�..l R�'• �Cf,'4C t4�as.�•.. I-�--t'��.,-- OTHER _.._ _.. `_ .r._ ! Jr __ } (; __ 1 Y ` �.. �������� '1r.[y�sraa:.. _ . ...-...._.,-.......r ..+.z_',C.'t-•: -> �,enn.r .�:+,-.m�>.-'. Ij r. � . � . 1'� c tL,,....,,,,,,,, ,„. , , _ , „ __ _ .. _ il,IMJPIIIIMWWMINIMIIIAIL _MIOJIIIII0I.IIIII .111111111 . _ MN ,, _- .1 Ls ____ IWIWIliWil..MOM- 001111111.4111111.111~.4 MiliMil. _ ..._I tom`-'Tt'OU'' S.`^„�. �."4s •L7^ --r+.. : HI ..t...s... . vr-r...-..f I .�,,, - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES �O Li I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY fj BOND Li 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 (i AGENT D SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information 1 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 ail Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7)// i' / PLUMBER-GASFITTER NAME � � \ '�: n.4 � -1 LICENSE # ` SIGN U � MP ( i MGF 0 JP 0 JGF® LPG! —1 CORPORATION[J# oilLellPARTNERSHIP(i# __...��.s 1 LLC D#1= COMPANY NAME: , �;11c G_ ADDRESS 145'S' 1V a r� Sr — - , CITY 112-vzia, ��.. _ ,.�.. ...,.. . . �.. . _..�...��•. _� STATE[aid ZIP2:3�j ___ITEL In. '1-1 41.11 FAX 101 2 _5 I CELL��.��„ JEMAIL ; P` -, ~' j 1 A r.t r? ', In")) y BUILDING DEPARTMEI�T By: --- --