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HomeMy WebLinkAboutBLDG-22-007048 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , 1 c CITY YARMOUTH MA DATE June 06,2022 PERMIT# BLDG-22-007048 - rl JOBSITE ADDRESS 34 DEACON ST OWNER'S NAME FIFE SANDRA L G OWNER ADDRESS 22 STILL BROOK RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 1 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF 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. 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 Vincent Marino LICENSE# 15136 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: IBEST YET INSTALLATIONS INC I ADDRESS. 110 Meadow Rd, CITY Spencer I STATE MA ZIP 01562 TEL 15088852378 FAX I I CELL I EMAIL Ipermits(a)bestvetinstallations.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 --F MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK cis CITY Imo. a�rrn_0, __ _ MA DATES a tg'-"---1PERMIT# L2- ?o�I B JOBSITE ADDRESS r3L1 D P4C.Qyn , . I OWNER'S NAME D h eth 4 ,oe,-,+ i G - OWNER ADDRESS TEL TELj�.1� �• FAx TYPE OR OCCUPANCY TYPE COMMERCIAL L i EDUCATIONAL 1 1 RESIDENTIAL 2( PRINT CLEARLY NEW:LI RENOVATION:L REPLACEMENT: , PLANS SUBMITTED: YES NO Ff APPLIANCES 1 FLOORS-i BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILERitMININ _ ... [ _ CONVERSION BURNER I 1 - 1 _ COOK STOVE - I OM" I ' DIRECT VENT HEATER II-' II , . I _ - I DRYER _ FIREPLACE11- g 'iri, FRYOLATOR ' .: WNW �'._ . r IMN FURNACE == 1 E. NM nil INN NI III IIIIIIIIIIIIIIIIIIIIII GENERATOR ___1 _ __ _ - , i L g, Ji _ ° : l ' GRILLE t iNS MIR .. f_ M INFRARED HEATER NM 1111111110111.11111I ; i Ir 11111111x M LABORATORY COCKS f ; I I _ I ! 1- MAKEUP AIR UNIT —I I OVEN I POOL HEATER ROOM I SPACE HEATER -11 , _ .. 1 0 z. ' it ROOF TOP UNIT 1 [ I i „ J I TEST 1 1 i__._ UNIT HEATER LLB NM 111111111111 r . . r i ;. __1 : t .- _ UNVENTED ROOM HEATER r, __ 1 WATER HEATER ______._.._.a...._..__.__ '11111111111111111 411111111111111111111111U illIlIlliI(IIIIIILIIIIII; IN MI6 OTHER f-.:_ 111111111MMINIRIMIIIII. _ _ II I _ .. __ r__1111115.. , INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES WINO [1 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY El BOND I 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 LA AGENT [-1 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 alllnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. c G.-- PLUMBER-GASFITTER NAME bin- — LICENSE#j1 I SIGNATURE MP 21 MGF Fl JP ri JGF LPG!( ) CORPORATION # I S PARTNERSHIP Li# LLC[]# COMPANY NAME:I e5t_ �I '1-, ..13 Ci_jGt-t1. 1S .fG ADDRESS[ . - ou) t--t�' . - -sue CITY S S G wt._..__ I STATE ;ZIP S�Ps iTEL I (j •$�5S a3 3 -x_ FAX 58 J 3 CELL _ IEMAIL' P)(104(: 5:_. 17 t "_1 5 t�.14.1. CO_ILY1 ._ _.,,._ ___ IPIII.-, •