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HomeMy WebLinkAboutBLDG-22-006979 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 02,2022 PERMIT# BLDG-22-006979 tt JOBSITE ADDRESS 11 CADET LN OWNER'S NAME Carlos Ferreira G OWNER ADDRESS 11 CADET LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 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 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❑ 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 ansoncelintvahoo.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 V EkfteACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK T( �y- VGtil MA DATE 5�"3 2L PERMIT 6 .` 1 2JOBSITB ADDRESS I I CFA- Lrt OWNER'S NAME C'(erlQS Wirr6ler-1., YUIL DEPARU TACDRESS 1 I C�p��' TEL S 8—�GU- 1419FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRtINT CLEARLY NEW:❑ RENOVATION: V"REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO ❑ APPLIANCES-1 BSM 1 3 4 5 6 7 �^ FLOORS-I ? � o, 9 10 11 12 '13 14 BOILER _ -j BOOSTER ___I C NVERSION BURNER, OOK STOVE ____1 DIRECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR FURNACE I-. - 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 1 WATER HEATER OTHER . I 1 INSURANCE COVERAGE �,/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL.Ch.142 YES ' NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1E OTHER TYPE INDEMNITY ❑ BOND ❑ t 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. ' 1. 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 `s 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 Statlumbing Code and Chapter 142 of the General Laws. A-ee°3 , '^/� I `I tlam/ PLUMBER-GASFITTER NAME LICENSE#37.455 SIGNATURE MP ❑ MGF❑ JP VJGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# 1 COMPANY NAME �' '(i(n f1/0414311 ADDRESS Ea C_xi�-f u di- 2(fin� Rh CITY Sot , eibfraraxikt STATE MA ZIP 04,44( TEL �S6$7,(.t'_1,�2 . I FAX CELL cbg- .('z6Z-d EMAIL fk+tsc,iet ['it-10y4#424 c - I G1 4 I � I F"` I w I Cf.! I 4. 1 I 4- I I i i k i I i I I a ❑ I I G mn w G1 I c,:, 0 2" F 0 I L.) iu G 1 ? F- I ak Fr I CG1 rc.T F: ,,, e 1 0 I LIS L Q � I- Ly zi FM °- 4 4e G3 Cti 1 L!_ I rUp C 0 I '- IZ 0 I I CA 1 Cli Cl) 1 4 I w I u A� 0 g 1