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Home My WebLink AboutBLDG-23-004086 _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .;'•° CITY EARMOUTH MA DATE January 24,2023 PERMIT# BLDG 23-004086 1/4: JOBSITE ADDRESS 57 GENERAL LAWRENCE RD OWNER'S NAME Kevin Marshal _ G OWNER ADDRESS 57 GENERAL LAWRENCE RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ 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 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 Tyler Bagge LICENSE# 26559 SIGNATURE MP❑ MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: TYLER BAGGE ADDRESS. PO BOX 2000, CITY SOUTH DENNIS STATE MA ZIP 026601613 TEL FAX ]CELL EMAIL baggepipinq anvahoo.com 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 i It- f—._N ` >-4 i `41 c �y1 MA DATE /_�v�3. J PERMIT# Z 3 - L-I°tY� R. =1E r--- --- - JOBSITEIAWRE•SS 5 7 (a erd14 I /IA:AirznCe OWNER'S NAME A' .n 1'itt- /e it GN 2 3 t f R I DUB ESS e7 TEL FAX tYPEO --- , ut-POP4% 1fJ 1 TYPE COMMERCIAL[1]rN EDUCATIONAL ❑ RESIDENTIAL.n— B rn tJEw: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES Zi NO❑ APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 1 9 10 1.1 12 •13 1! BOILER BOOSTER { CONVERSION BURNER —COOK STOVE DIRECT VENT HEATER DRYER , 1 t— FIREPLACE FRYC)LATDR FURNACE --- GENERATOR GRILLE INFRARED HEATER ____,______. , LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER —~ ROOM/SPACE HEATER ROOF TOP UNIT — - TEST . . . -- _.... UNIT HEATER (INVENTED ROOM HEATER WATER HEATER — OTHER DAer 0(-)10( �--r 5i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er 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 waivee this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT r'I-• I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate o he best of my knowledge and that all plumping work and installations performed under the permit issued for this application will be in compliance with rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.Lij PLUMBER-GASFITTER NAME LICENSE# Ss�J SIGN:�� MP E MGF[] JP El JGF❑ LPG( ❑ CORPORATION// ❑it PARTNERSHIP[]# LLC #COMPANY NAME !4` %�� he- �l� -- /Y ADDRESS 3 ) U " e rt 4--/9l7•I- n CITY /�t w,CA STATE /21/7 ZIP d,,, & 9 TEL 77V-c936-3•52d FAX CELL EMAIL `cj j r,/)•e+` e l�4r: c vti ( H z H c) co) 67,1 w"1 ti I w I rz4H 0 C1' rn w. i r� w - o G7 IL r d Ci U3 l4! I- u U1 .+ 1 ti C Cr] II �1 U r� V C