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HomeMy WebLinkAboutBLDG-21-006860 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I ` CITY YARMOUTH MA DATE May 25,2021 PERMIT# BLDG-21-006860 Ii E 0$ JOBSITE ADDRESS 61 FLICKER LN OWNERS NAME john beauchene G OWNER ADDRESS 61 FLICKER LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 FRYOLATOR FURNACE 1 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 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El BOND 0 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 Gary Famigliette LICENSE# 10191 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP 0#` LLC ❑# COMPANY NAME: GARY FAMIGLIETTE ADDRESS. 67 MAPLE AVE, CITY HYANNIS STATE MA ZIP 026014403 TEL FAX CELL EMAIL FAMCO @COMCAST.NET ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ El FEE$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK m = CITY u 91c. , , in36,1 MA DATE / PERMIT # BC D6-1 (-00 osivo ...,,„ ____ ; JOBSITE ADDRESS _ le ie _. ev JOWNER'S NAME LTA&_eixiir.P.Aze_ t GOWNER ADDRESS TEL FAX1 TYPE OR A OCCUPANCY TYPE TYPE COMMERCIAL I L...] EDUCATIONAL Ei RESIDENTIAL IA PRINT CLEARLY \JEW: RENOVATION: REPLACEMENT: I.74 PLANS SUBMITTED: YES 4 NOA- _ APPLIANCES -1 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 • • --- FRYOLATOR , ., _. FURNACE J v — — - GENERATOR r - -_ .--- --_1_-_ '‘ 4.11.1.1- -'4"''•-•— GRILLE INFRARED HEATER LABORATORY COCKS ., _ , . MAKEUP AIR UNIT f`. ,k •lw - OVEN i POOL HEATER . ROOM / SPACE HEATER ROOF TOP TOP UNIT TEST - --- - - UNIT HEATER ..... UNVENTED ROOM HEATER • WATER HEATER / , , , OTHER , . , ----- -,....---,t,-,',/1".. 0-kr, T•ls:,C,:-.• d,.. V—1., f, , _ , .. ,, ....,....,..w...,,. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES I v NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v OTHER TYPE INDEMNITY BOND I 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 hereby certify that all of the details and information I have submitted or entered regarding this application are lai and accurate to the best of my knowledge and that all plumbing work and installations performed under the permrt issued for this application will be in li ce with all Pertinent provision of the - Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -- ..._ PLUMBER-GASFITTER NAME Gag Famigllette LICENSE 1[10191 — SIGNATURE MP v MGF JP JGF LPGI ! CORPORATION # ' PARTNERSHIP # LLC # COMPANY NAME:i Famco ADDRESS 67 Maple Ave ,....._ _ ,,.,......_. .., CITY Hyannis 1 STATE Ma ZIP 02601 TEL 508-775-5525 FAX CELL 508-280-5525 EMAIL'Fameo@comcastnet