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Home My WebLink AboutBLDG-23-002188 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tlel- CITY EARMOUTH MA DATE October 24,2022 PERMIT# BLDG-23-002188 JOBSITE ADDRESS 166 SEAVIEW AVE UNIT 5 OWNER'S NAME SALEMME ROBERT F G OWNER ADDRESS SALEMME LOUIS SR 25 GROUSE LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:0 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/SPACE HEATER 1 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY 0 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 -egarding this application are true and accurate to the best of my knowledge and that all plumping 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 Anson Celin LICENSE# 32655 SIGNATURE MP 0 MGF ❑ JP El JGF❑ LPG! ❑ CORPORATION 0 # PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [NSON CELIN ADDRESS. 26 Capt.Blount Rd, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX ]CELL EMAIL ansoncelin(@,yahoo.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 yf� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t .>L rix' CITY (; ,A+V- C VNIO,,:. '4 ;� MA DATE PERMIT* 2-- --32-,CC JOBSITE ADDRESS 16 6, $t6-,V,eV)a re, 4 S 3 OWNERS NAME_gr12G rr� OWNER ADDRESS - 67- C Lam,0-e ttt51 V rm6-4 EL 1-6 . Z -<L GI Z TYPE OR FhX PRINT OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL Kr CLEARLY NEW:❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES T FLOORS—+ SSM 1 2 3 1 5 s o BOILER s to 11 12 l; t BOOSTER CONVERSION BURNER J COOK STOVE _____ DIRECT VENT HEATER J !_ DRYER FIREPLACE - FRYOLATOR - __ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ---, __,_____,_;_+ MAKEUP AIR UNIT OVEN • i _ • PDCJL HEATER • ROOM 1 SPACE HEATER 1 ROOF TOP UNIT TEST I _ H UNIT HEATER _ UNVENTED ROOM HEATER j WATER HEATER OTHER i INSURANCE COVERAGE - I have a current liabili 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 1( 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. • SIGNATURE OF OWNER OR,AGENTCHECK ONE ONLY: OWNER ] 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 `s- and that all plumbing work and installations performed under the permit issued for this application will be in compliance with aJl Pertinent provision of the �` Massachusetts State Plumbing Code end Chapter 142 of the General Laws. l L PLUMBER-GASFITTER NAME / ply ` LICENSE it'3 --6: 5` SIGNATURE MP I I MGF❑ JP JGF❑ LPGI ❑ CORPORATION❑4 PARTNERSHIP❑# COMPANY NAME_ C_e I. Oi ,,yob}. �i ADDRESS Lctiri LC❑#t AZ CITY n ,,, Vf Acrn U STATE Al 14 ZIP 0 2-G G Lf TEL FAX CELL L-07-Z4 (;- L4(�;7_ EMAIL TISm Ctir-mot(3Y l/cx,. ( U,YI ROUGH GAS INSPECTION I'10TES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑• ❑ FEE: $ PERMIT# PLAN REVIEW NOTES