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Home My WebLink AboutBLDG-23-003612 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�=� January BLDG-23 003612 �', CITY YARMOUTH MA DATE 03,2023 PERMIT# JOBSITE ADDRESS 1 &3 TRENTON ST OWNER'S NAME FACCHINI RICHARD A JR G OWNER ADDRESS 156 SPRINGFIELD ST SPRINGFIELD MA 01107 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 1 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❑ 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 he in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Dennis Gagne LICENSE# 9804 SIGNATURE MP 0 MGF 0 JP❑ JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME FINIS M GAGNE ADDRESS. 31 Cherrywood Ln, CITY Marstons Mills STATE MA ZIP 026481761 TEL FAX CELL EMAIL gagnedmg51 naol.com S310N M3IA32J NV1d #JIW2i3d $ 33d ❑ ❑ .IW2i3d 3H1 SV S3A213S NOIlVOIlddV SIHJ oN se), S310N N01133dSNI 1VNId A1N0 3Sf1 N0133dSNI 2J0d 30Vd SIHl S310N N01133dSNI SVJ HJl0J 11 _ � HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK __ — _1_ CITY %fie — I MA DATE&,�?16-- 2 Z-- PERMIT# .f 2 1 I OWNER'S NAME 7/:;7::D 6-ci c c i 4 t ;�''�G"G D.-O EERcAIDDR:SS TEL ,FAX` j L.TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL;] EDUCATIONAL J RESIDENTIAL - CLEARLY NEW:;J RENOVATION:Li REPLACEMENT:— PLANS SUBMITTED: YES J NO J APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ____I__:__I,..._-,______;:_i_____I_J ______1 — —J—J I-J J BOOSTER —J i, I I . . 1-J__Li___1,____) 1 1 f CONVERSION BURNER _ J J_J—I I._J; l. 1_J:__ _J I '� COOK STOVE . i I '��- -- '—I:-1--I—J_I—] - - ___I___I -_1 DIRECT VENT HEATER _i__}_J ___J.___I___J - j_J t__I_ _j _J____1DRYER- J__I:____IJ J I—I I.____I.____I-� —J i—1 . 1—! • FIREPLACE I_J—J _" - ! —J I_� _ i-_Jj—i.—J—1 FRYOLATOR ' —r� —. 1 - 1_J ___.I___.I:_ . f_I __I_JD__I __IFURNACE - _J—J. I - I I_I � I i .._I —^J .—fr—J 1GENERATOR 1I 1. i ____i I 1�J____J _ J—J__J�! GRILLE __ I. . -L-_J______I_I. I_J.___J_.._ --1..J___I___. J —.I INFRARED HEATER '1 1_—J—1 1-___1 ;� c;—J __I,—J—J�,�J LABORATORY COCKS -I J i—i._J—j ! 1 J.......___I__.._..__ 1._._1_-11_1_I itMAKEUP AIR UNIT I ` .... I'--J_._J______I1_,_ 1—_J_I _____I_i___I--i..__1 , OVEN -- I i . I - .. i__-1 LLI I -J I _____j_.J__—J____I .I a POOL HEATER —J_ —J _J'—�.. _I . _ . __ _-�__-_J�.��___1_._____i- _ _ _ _ � ROOM I SPACE HEATER I. I�,. 1 1 I I I I i I 1 1 l ROOF TOP UNIT ____...1 I r_I 1 I____ !' 1 __I I i__j i TEST i I I I I 1 i____..I i i i i I:- - 1 c UNIT HEATER I_____i I I i l_J I -J i___.J:__I_—j UNVENTED ROOM HEATER • _—J_J i i i ! I,_,___ ! I_J_J—� ______i___1 -- WATER HEATER . ----- --- _ ___I .. .. 1 .. _ I _J I I.,J_I„_____I — 1 1J—J_____IOTHER,_;_ I_____I i _ — I.—._1 I._____!,—_.1,_._J__L-1,-1—1.____i.__J 1 ___J L ... I I___._._I.r_J__J_:__3 1 ( i__.__J__IJ__:_-1J I_J - -_. 1 -.-1. . . I _.._ .I 1 i _ - l Ic ._J I 1 ..__I.__ , I 1 I INSURANCE COVERAGE _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 4-NO ;.J 14 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY J BOND L—s 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 III AGENT J 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. PLUMMBBE ERR-GASFITTER NAME 4�,n/S'j1j. ' I LICENSE#1 a` -/ 1 SIGNA MP NiGF'...:3 JP.2.1 JGF',11 LPGI J_ CORPORATI01� 23'/ 1 PARTNERSHIP '# ' LLC # - _- COMPANY NAME:,W)—,//I i'// 2 C ADDRESS Il /-17l- I STATE?/-7‘ !ZIP .,22/7y� (., ��6�7%[ CITY CI, �1Z r '~ TEL � FAX _I CELL: • ,EMAIL -7L%IeQ�ICv-1_'/ QaL�6�' 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 •