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HomeMy WebLinkAboutBLDP&G-22-000452 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK --=`, 71 ;V CITY YARMOUTH MA DATE July 23,2021 PERMIT# BLDP 22-000452 Y` y JOBSITE ADDRESS 127 WENDWARD WAY OWNER'S NAME YOUNGLING ERIC G OWNER ADDRESS YOUNGLING RACHEL A 127 WENDWARD WAY WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 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 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 ❑ 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 Ralph Giangregorio LICENSE# 9339 I SIGNATURE MP© MGF ❑ JP❑ JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: RALPH J GIANGREGORIO ADDRESS. 188 Route 28, CITY Dennis Port STATE MA ZIP 02639 TEL FAX I I CELL I . . I EMAIL office an.3gsplumbinq.net S310N M31A3a NVId #1IN d $:33d ❑ ❑ 11W2i3d 3H1 SV S3A213S NOIlV31lddV SIHl oN saA S31ON N01103dSNl 1VNId AlNO 3Sfl N0103dSNI li0d 30Vd SIH1 S310N N01133dSN1 SVO HOl021 t1 ' L�j_J;� t TT l-' 4a,., 5 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK It}l CITY Li '.. .L1 MA DATEL2.-7(...cilPERMIT# JOBSITE ADDRESS[,j-7._�, � --� - OWNER'S NAME LJrJ4J G OWNER ADDRESS , =,..1&..6c1, 21.--......A. TE 2aO FAX TAPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT �,,,y„� N - CLEARLY NEW:0 RENOVATION:El REPLACEMENT: E. PLANS SUBMITTED: YES NOR . APPLIANCES `l FLOORS--' BSM 1 2 3 4 5 6 7 8 9 r 10 Ni11R 12 13 14BOILER .__ ,_._-- r� ..Jr...•_.�. ; _M aLmii.l iM BOOSTER � - :� .�,�� . . .1!IMA' pprJ r---w i7',.irm---n---i-i iSlNlti„-l-lt'i, 1111♦-,-•�I�za• I.cro�.W. ,�.�,,,,� �^_; � _ . �.« . . t,,. ,-,.q.. CONVERSION BURNER I 1 _ k COOK STOVE .. J; - - -DIRECT VENT VENT .�� .: _. -- _ _ _ -- _ ---- HEATER - _ 1 DRYER i- 1 I _ FIREPLACE r -- - �' i� � �. �!'� -��.��I FRYOLATOR MI�^..•$1,0—M M .I�e�� u ..Fes{ �� L�, ► '11 ..1111 FURNACE --- '*i■rIIII .�.. ,�.._.�_[_. .._�__..__. . _ _ �_. GENERATOR 3 , �, 4�97 d97i l Off7mlll GRILLE M L _ _�-h ig��.z,�� -- --; - - - � ..I. 1� _ .,, � INFRAREDHATE , •._.�.��r..-�.,�, _ -„,, 171 � ,: II„ ., .i - HEATER e` ,�,_. _r._ Y• :, LABORATORY COI. -• - -s.s - - — ' ' .' • f-xr•.w..+..1.., ,e.. ,,„, pow 1- •..Tr. . . .�xr.•— rim •�•^.tI t _ __-_ _- _ .. yt. rl-�e.l. MAKEUP AIR UNIT �i r u x"" OVEN — ��: -- - -� -:, __ _ii - •��__._ 1111 1111111M= {:7-- -j-v - --.53 Iv.- ' - -Ai - &omit pp HEATER �_ _ . ) ROOM/SPACE HEATER t. .__L--*T -- .v tialliitiliNfiliglitil ROOF TOP UNIT J TLM fary. ii i .tea. .��- , I[alit11110014.1 TEST 1 _ --� ,HEATER UNIT - --. - -- ---- --•-•-- _ -- ��___-._._.3 UNIT NTED R HEATER IIIIM►•...� _ 1 -- L1� i� - .ffl � � iiiiiIIMISI WATER HEATER _ - - - l. . OTHER__ u'G7'14�::'7k�i:6isJS,.ifStSY.:s.3\i W:1'.Z.^J�'J!�71�fS�. ••... +1'... r _ TIS r.. .o..+K....�...na�.ti.a INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL, Ch, 142 YES faii0 i IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE-BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Di OTHER TYPE INDEMNITY 0 BOND L, 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 0 AGENT 0 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 Stale Plumbing Code and Chapter 142 of the General Laws. V UM R-GASFITTER NAME .bCI aa7.,:S./: __. LICENSE#. 3., ff SIGNATURE MP ECI MGF 0 JP 0 JGF 0 LPGI CORPORATION # 31.QJ._ PARTNERSHIP #L __w...,j LLC( # ::1 COMPANY NAME:1 10 bi` ����•�•�{♦''�+) ADDRESS t S' /I{{{(((///��{��'��,•{f/////////�����'��',J//q/ b, t;,_.,<...,._ NC���E/N'��'^ • 1•tMe.+w*» wlN.r�....St; MA Y•, uJ[.ii{Ij�L�_^-^s'"•_- '-W.G�GiG•1fJ.Y(�• '�YI�ORf.Gf�. CITY LfliE . _. . STATE . ZIP '3 I.._ ]TEL.7.+w+r_.,,r,_+.,a, ,. r..r,-,a vv�.....�,�. _.a , FAX LSD 9`�. J CELL r,.-. EMAIL } -' - i . t„,,,_,__._,___,___,..„,„,,„,,J i1 A-P.' pig RcEc- _� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK mj°y CITY •L u. IJI"tCv MA DATE 7-/c(-)I PERMIT# p JOBSITEADDRESS��7 ���'IC b- '4 V�--Cti OW//NER''SNA/ME "1-6c_ � cYC✓(�Ity POWNER ADDRESS :}-1 LC-Via.,�it^J (l-%C,� TEL 6) / -6.51-'fUsFAX �J TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL El RESIDENTIAL OP PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:Qf- PLANS SUBMITTED:YES 0 NO. FIXTURES 1 FLOOR-. a5M 1 2 3 4 5 8 7 B 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE - DEDICATED SPECIAL WASTE SYSTEM - DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN - INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN - SHOWER STALL - - - SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES , WATER PIPING OTHER - [ . . INSURANCE I have a current liability Insurance policy or its substantial equivalent hich meets the requirements of MGL Ch,142. YES'NO EliIF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LA OTHER TYPE OF INDEMNITY❑ 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 CHECK ONE ONLY: OWNER❑ AGENT 0 I hereby certify that all of the details and information I have submitted or entered regarding Ihls application are true and accurate to the best of mylmowiedge and that all plumbing work and installations performed under the permit Issued for this applicalionwill be In S�SS0000 pliance wllh all Pertinent provision of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. // s/% PLUMBER'S NAME (�l1l, '7 '_."-' (` -icn: cc;,^,u; LICENSE 33q - SIGNAI1RE MPg. JP 0 CORPORATION 214-1,--Lei U C PARTNERSHIP❑# • LLC❑N COMPANY NAME-IV,-'‹; PG j„"10;';,-1,-,,.4- P �} ADDRESS 1!I-Cs 1V(1(,- - CITY UP,)nlS 1'C�,' J STATE 4)rn` J I ZIP (''P./,:3 ci TEL FAX,, TY �n 4 ( CELL EMAIL ''(o )�` d , - •yl2