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HomeMy WebLinkAboutBLDG-22-005306 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 23,2022 PERMIT# BLDG-22-005306 rl JOBSITE ADDRESS 81 CHIPPING GREEN CIR OWNER'S NAME DADDANA JUDITH F G OWNER ADDRESS 81 CHIPPING GREEN CIR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: m 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 _ 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:ug line in trench 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 Francois Paravisini LICENSE# 15211 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: FRANCOIS PARAVISINI ADDRESS. PO Box 2585, CITY Orleans STATE MA ZIP 026536585 TEL FAX CELL EMAIL bayside(a2thecapecodplumbers.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 ?._;f1i= CITY yrArr►�-o U�c__-____ _ MA DATE171/(4)- I PERMIT# _ Z2 - ¶3 47 • JOBSITE ADDRESS 1 et d L 0 .n�j( (�►.r .. . OWNER'S NAME I �t GOWNER ADDRESS G/ I TEL S O331cr« 1 FAX L� I TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL D RESIDENTIAL 21 PRINT CLEARLY NEW:LJ RENOVATION:Li REPLACEMENT:Li PLANS SUBMITTED: YES Li NO LJ APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTERRR,. (.--11 CONVERSION BURNER i � �, COOK STOVE `, 11.1111111111111111MMIWW DIRECT VENT HEATER I ( l ' . s n _ ' _ :_. DRYER IA II —' FIREPLACE ! — FRYOLATOR RR ,itgLM . I . ,_ _.. , , FURNACE GENERATOR , GRILLE ` . _. t . ,. ( ___ 1 _, i.. .. 1 i _ v _ II INFRARED HEATER I: -_,. ,`... h ... LABORATORY COCKS111-11. -1111.Millilliiiii MI' iMl MAKEUP AIR UNIT IIIIMIMIIIIIIMIMNIIMMIE MIWIMINCIIIIIIIIIIIIIIIMOINF' OVEN V 1 !armaiii_womix,_ ':. _ s r----- _ POOL HEATER ", ROOM/SPACE HEATER ; 1 ;ROOF TOP UNIT i ! i .._.. _ TEST UNIT HEATER _7 �-- 4 IE- ,- UNVENTED ROOM HEATER ----AgatotLi, WATER HEATER OTHER j G— L he, i I; g, . �, O.allii ice'iiii M ' INSURANCE COVERAGE _ I have a current liability 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 V OTHER TYPE INDEMNITY ji BOND Li 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 Li AGENT L SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application ar e d accurate to the best of m edge and that all plumbing work and installations performed under the permit issued for this application will be' ompli with all Pert ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME FRANCOIS PARAVASINI 1 LICENSE#�152 1 1 SIGNATURE MP I MGF JP JGF LPGI[ CORPORATION #14288 1 PARTNERSHIP L #L __ } LLC[J#I __-... COMPANY NAME:SNOWS FUEL CO J ADDRESS 18 MAIN ST } CITY [ORLEANS 1 STATE MA IZIP 02653 f TEL 508-255-1090 FAX r _ p CELL E EMAIL[bayside@the cape cod plumbers.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