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Home My WebLink AboutBLDG-23-002058 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '"I- CITY YARMOUTH MA DATE October 18,2022 PERMIT# BLDG-23-002058 I.1 JOBSITE ADDRESS 22 WIDGEON LN OWNER'S NAME MARTIN JUDITH A G OWNER ADDRESS 22 WIDGEON LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 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 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 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY ID 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 Briggs LICENSE# 12901 SIGNATURE MP 0 MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: BRIGGS&HEINO I ADDRESS. 36 ROLLING HITCH RD, CITY CENTERVILLE STATE MA ZIP 02632 1 TEL FAX CELL EMAIL brippsheinolSS.gmail.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 tZ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY: Gl,r VYl 0 U MA. DATE: I D ( I l a a PERMIT# JOBSITE ADDRESS: g a VV 1C�' Y� L✓l OWNER'S NAME: E ea Ac(1 Ca ✓y.p G OWNER ADDRESS: a g- w L{7y)Ln TEL:�45• 531• b2kS FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL �\❑11 EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:6. PLANS SUBMI I I tD: YES❑ N6ft APPLIANCES-1 FLOOR-, Bsmt 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 _ lr} INFRARED HEATER a LABORATORY COCK V V MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER �J ROOF TOP UNIT V TEST 1- UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 � _ INSURANCE COVERAGE �, I have a current liabilit+tinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES u NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY In OTHER TYPE INDEMNITY 0 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. _ CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 al plumbing work and installations performed under the permit issued for this application will be compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: r _S flaYI 47 Q1 LICENSE# I anc1 D I } IGNAT COMPANY NAME: , 1�Y1_ r1 S `i- � .ti) J ADDRESS: 3�' Lb V1 tit--t(h Y�p \ CITY: - It e Y✓r STATE: ►71 ZIP: O a la 3a- FAX: J TEL: 8.•�i). Ok L/ CELL: 51)k•. � On , a' gEMAIL: r 1 1 5 he 1n 6 CZ r /i 1r ( . .[I MASTER M JOURNEYMAN❑ LP INSTALLER❑ CORPORATION # 3ay PARTNERSHIP❑# LLC❑lr E/r, ADDrze-Ss : r►n9 5 het n b C aynctI I ,(tr rrn