Loading...
HomeMy WebLinkAboutBLDG-23-004552 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �, gi CITY YARMOUTH MA DATE February 15,2023 PERMIT# BLDG-23-004552 Li- JOBSITE ADDRESS 5 DUNDEE DR OWNER'S NAME Leroy Quinn G OWNER ADDRESS 5 DUNDEE LN YARMOUTH PORT MA 02675-1518 TEL 5082404762 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 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 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 OTHER 1 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND El 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 Anson Celin LICENSE# 32655 SIGNATURE MP 0 MGF ❑ JP© JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ANSON CELIN , ADDRESS. 26 Capt.Blount Rd, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL ansoncelin(a),vahoo.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 t CITY YARMOUTH‘4., MA DATE February 15,2023 PERMIT# BLDG 23 004552 "i� JOBSITE ADDRESS 5 DUNDEE DR OWNER'S NAME Leroy Quinn G OWNER ADDRESS 5 DUNDEE LN YARMOUTH PORT MA 02675-1518 TEL 5082404762 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ 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 _ _ 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 OTHER 1 OTHER DESCRIPTION: r]2< p,j 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 El 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 as 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 0 JP© JGF 0 LPG! ❑ CORPORATION❑# PARTNERSHIP ❑#I LLC ❑# COMPANY NAME: ANSON CELIN ADDRESS. 26 Capt.Blount Rd, CITY South Yarmouth STATE MA ZIP 02664 TEL FAX CELL EMAIL ansoncelin(a)vahoo.com P •T• I V F SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY WArvh.ou' Sl 904 10, DATE Z /S_ 2 PERMIT# 5 2023 JOBSI E ADDRESS- 1 .4t1 0 t OWNER'S NAME Lori CmetG 'QJt a nrt cut L[ D.NHWTADDRESS S` bpi ,��` TEL 1b1- 9ZZ- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL LJ PiRINT I CLEARLY NEW:[� RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO APPLIANCES 1- FLOORS-4. BEM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER r 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 OTHER ("F.rC i�- / INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES (/(]ENO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 compii ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. J� PLUMBER-GASFITTER NAME LICENSE# 37 6fs SI NATURE MP❑ MGF❑ JP["JGFF 0 LPGI ElCORPORATION❑# PARTNERSHIP El# LLC❑# COMPANY NAME (I;•el W 1 76,rj- ADDRESS 2 Catilvtizz 644,01 lqp CITY 500-t Gr tiarma(A fh STATE M 14 ZIP Oil G V TEL 6-6&- (icy_WIG 2- FAX CELL EMAIL ALSevict/i4 ai k -i G�'1 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