The URL can be used to link to this page

Home My WebLink AboutBLDG-21-007349 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 17,2021 PERMIT# BLDG-21-007349 :Ii JOBSITE ADDRESS 35 WHISTLER LN OWNERS NAME thomas rust G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ 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 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 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 ❑ 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 Robert Lalime LICENSE# 13701 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: IROBERT C LAME I ADDRESS. 575 Main St, CITY IMashpee I STATE MA ZIP 1026492054 I TEL FAX I I CELL I I EMAIL Inone • 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 . " ---E•anl..F_--=, ,i, CITY ttA0-6;t7456-4 a -Totdiz.- ----- I MA DATE: a 76 7, -----i PERMIT# TSL-D6-1(- cb73 LI i . - ,...- ,...., JOBSITE ADDRESS.T---35---,,,---p-t .4-- ---c----cA)----1 OWNER'S NAME : . TO AA. GOWNER ADDRESS i 3 5-- civ Xi 2 ~[-e- k.-- -----t----iti: ---------- — I TEL - - - .-- ------7FAX' -1: . _ .., . TYPE OR OCCUPANCY TYPE COMMERCIAL:,..1 EDUCATIONAL J. RESIDENTIAL rk PRINT CLEARLY NEW: ..11 RENOVATION: /LI REPLACEMENT: ____1 PLANS SUBMITTED: YES Di NO r_i APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER . • 11: 1.____j_ _i ' I, L_Li_I__L__I _1 I ____:1__LI _LLI BOOSTER :Lli __,- 1; 1 t l., L_I ' 2]- - 1 =_i J _."r__ 1 __ CONVERSION BURNER . /, 1 I _ 1 . I ( _ I _I, I i _ I _1 __ Th • I COOK STOVE _1 i I- : • 1 I'LL 1 tL:L1:J__. I 'LL],-L___I 1 .__ _Li JI _ ___1 DIRECT VENT HEATER ._____I 1 CI:L._i _i _____J - -1 _J. : f .1 :- ' - I 1:11], _1 DRYER • : -- L1 . I • I• ! ___.1 1 ' - FIREPLACE - -1 - 1 . - 1 I - 1 . 1 1 - I - I . i I -- I 1 - I i 0 FRYOLATOR ..____-_1- I1: I 1I, I __IT_ 1 _i L-___/Th ---- i --,j ___ I . _ 0 FURNACE :-____1 :-- - 1-LIi - I I ___I i ____ __1: 1 ____I __J,. 1 1 GENERATOR _ GRILLE ( INFRARED HEATER LABORATORY COCKS 1 - I. I ---I I _ I I _ 1 1 ' ii i -- - _____ _.I __ _ __J __,___1 _I ______1 ______I __I ..._____I _.1 _---J- ,:_:::_.:J _:_:.i, - - 1 _:____--1 .JHI ----_____H .:_ -_-_ 1 ...____I 1 __-___I - 1 - - 1 . i ; ______I ' - I - I - 1.._____I ______I ______1 1 _1 _____I itMAKEUP AIR UNIT i ____ I LLI ...LLI __Li 1 .._-__L_____I ______I __I 1 _i_Li 1 _ _____I OVEN 1 __,........! ( 1 I- LJ i J __I 1 ' I 1 J POOL HEATER . ' 1 I, 1 , 1 J... J I I __I. ___I __J 1 j___I _____J ROOM/ SPACE HEATER :- - -` - - 1 - i - 1 L f ___Li 1 _ - i 1 1 * i.................. _,.. .._._ _. _ . . ROOF TOP UNIT 111111 ___11 : 111 __ TEST 111 . , _ i I i 1 . f I UNIT HEATER , 1 i . , , ; : , i- 1 ) j .. _____.,—J --.1 ___ --1 _1 _ UNVENTED ROOM HEATER . -... .J --j .-..--1 ---i --i ! --:1 ----.1 _1 _LI _L__1 1 _1 __1 1 WATER HEATER , Av 1 r• 1 I i, ! 1 _ __I j, I ! 1 . 1 . I OTHER I i__ -___ __- .j __j J_ 1 •_____Li_ _ _ __ _ _ _ _ _ _ . , , • i 1 - I I -_ ' 1 I _ _i _____J :_____1 . 1 _ I -I - r 1_:. - i 1. . _ _ .___J ______J __I _ !_ I I __J 1 _1 1 _ I __I- . . 1 ::::_:L! ..—"i -__ [ - - '1 ,_ 1 . I -_-__ I I , ' j -- -1 .-- t - INSURANCE COVERAGE : - i I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Li1 ,___1 NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _H7 OTHER TYPE INDEMNITY 7,:j BOND r--1 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 71 AGENT ___I SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and a , - to - best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance , - P:)• ent provision of the Massachusetts State Plumbing Code and Chapter 1 2 of the General Laws. - j ...0 _._ ...,„L. ,...... , ._ PLUMBER-GASFITTER NAME : VA9 v--)t-7 I dvt't) LICENSE# 137:101 - -A b I I 1 MP ...._V MGF ',1 JP J JGF ' 1 LPGI 1.1 CORPORATION -1#7 [ PARTNERSHIP-...J# LLC ......1# t ..,_ ----COMPANY NAME:' -e- tj. 6 V-/- 7t&-6--- I ADDRESSIt ,-------------,1- .'i,t— I CITY A /1 ISTATE bZIPO TEL FAX _ CLL [EMAIL - I FCLV : JUN 1 6 2021 I ....._ J BUILDING DEPARTMENT By ---------- - ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE:$ PERMIT# PLAN REVIEW NOTES A UAW V&A VS. •