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Home My WebLink AboutBLDG-21-003117 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 3_=1" -=‘ '6 CITY YARMOUTH MA DATE December 02,202( PERMIT# BLDG 21 003117 JOBSITE ADDRESS 31 FILLMORE RD OWNERS NAME HIGGINS THOMAS F G OWNER ADDRESS 3 HIGH ROCK RD DOVER MA 02030 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 1 FIREPLACE FRYOLATOR FURNACE , GENERATOR . GRILLE 1 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 El NO El 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 Chris Lafrance LICENSE# 26347 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: CHRIS J LAFRANCE ADDRESS. 36 OLD MAIN ST, CITY LYARMOUTH STATE MA ZIP 026645645 TEL cl -3 l' - I ke:6 FAX ]CELL EMAIL i� 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ALA_ CITY /(Gfokd v'4' ham, DATE 1,1, 197IZ V PERMIT*a - a-I-)b31l . a tg , (lac,- JOBSITE ADDRESS 3 +i l r,.oi - (A OWNER'S NAME SuM► GOWNER ADDRESS I r i i v'r� fA TEL 3 19-181-1'1 QC-FAX TYPE RINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALX CLEARLY NEW:❑ RENOVATION: K REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ i APPLIANCES FLOORS-, BSI 1 2 3 1 5 6 7 a 9 10 11 12 13 14 I BOILER ! wL►-ate i BOOSTER CONVERSION BURNER / COOK STOVE r/ DIRECT VENT HEATER / i DRYER �/ --- 1 FIREPLACE R F C. PJ zip _ D, I FRYOLATOR I 1 I FURNACE 4 GENERATOR I i, Lv Vo 1 F INFIRAREDHEATEf. ��,! „n ! �� LABORATORY COCKS - — "� MAKEUP AIR UNIT S OVEN L_ POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST . - . . . . ._ UNIT HEATER -^I (INVENTED ROOM HEATER I j WATER HEATER OTHER I 0 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESVO ❑ • — I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE EY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. _.4 -, CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 7.lti I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accura` o the best of my knowledge `s- and that all plumbing work and installations performed under the permit issued for this application will be in co Ii nce wi &rtinent provision of the -` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4Z PLUMBER-GASFITTER NAME LICENSE 4 212317 :91?-----sGNATURE MP ❑ MGF❑ JP IJ JGF❑ LPGI ❑ CORPORATION❑4 PARTNERSHIP❑4 LLC❑# COMPANY NAME C.— - T- �%z�...v� -F1 is I AK- ADDRESS ✓v 01 b ✓�'�4-!.N s I CITY Yhronbu STATE 1414- ZIP 026,6 `I TEL sbe-SO- 1906 FAX CELL ;36 4 —18a'6 EMAIL leelle-GA-C,G Pat 0 411 _•CO►-. 1 1 fl f G'! 14 H . 4 0; I 1 1 C. R I P: —. f••c I i I 1 i I 4 I cu I-- &rj 1 64 H l E—' 0 I UU L I CG Cr) W.: — I 4: - .Cl) . �i . Cl) .,y 0 GJ < Hl E_ EL. Ca iii l LB I f-- LL l I I 1 1 CO ci 1 N I a—' 0 C,�) I 41 I I I uri I C. C> I