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Home My WebLink AboutBLDG-22-005364 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Lr; CITY YARMOUTH MA DATE March 24,2022 PERMIT# BLDG-22-005364 JOBSITE ADDRESS 17 CAPT DANIEL RD OWNER'S NAME MAURINO DIANE E(LIFE EST) G OWNER ADDRESS C/O COLLEEN ZAPPALLA 12 VILLAGE GREEN NORFOLK MA 02056 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES ❑ NO❑ FIXTURES FLOORS-+ BSM 1 2 I 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/SPACE HEATER ROOF TOP UNIT TEST 1 _ 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 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP 0 MGF ❑ JP 0 JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbride(a)gmail.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 CITY MQ V T MA DATE PERMIT# 22 -S3 vi JOBSITE ADDRESS l 7 ( 7v 'I ) q r)i eLAztOWNERS NAM GOWNER ADDRESS /Z-V/i/ ' e 6 P-et,,, 5 � " TELL/7 - b FAX r• �c. V 4- TYPE F` OCCUPANCY TYPE /�C MM�RCIAL�� EDUCATIONAL ❑ RESIDENTIAL reE PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:❑ `re3> PLANS SUBMITTED: YES❑ NOIki APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 1'1 12 is 2 BOILER _ BOOSTER _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR t FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS . MAKEUP AIR UNIT _ - OVEN POOL HEATER . ROOM I SPACE HEATER _ ROOF TOP UNIT TEST . / QiC 214i(4I f-- ..... .._ .. _._ UNIT HEATER UN VENTED ROOM HEATER 1 WATER HEALER ,ER —_ 4 OTHER RECEIVED H [MAR 2 2 2022 INSURANCE COVERAGE I have a curreitiibi ieepeliep1-Dr is substantial equivalent which meets the requirements of MGL.Ch.142 YES t�2 NO ❑ By' I IF YOU CHEC ttu YES,PLEASE INDICATE THE PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY kil 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 compliance with all Pertinent provision of the " 1 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 ci($( c-L` PLUMBER-GASFITTER NAME LICENSE# SIGNATURE MP ❑ MGF 0 JP JGF❑ LPGI pcli CORPORATION 0# PARTNERSHIP❑#, LLC❑# COMPANY GAMEn / t i �)a I-L1- ADDRESS -3 7 i- 7P f lC/1c 4--fre4oe CITY I 4 r) I c STATE V v 4. ZIP 0 .(Q O/ TEL?7 W O ?I FAX CELL EMAIL.4-111 +pa r►dC—O' Of c w4-rLb C ROUGH GAS INSPECTION NOTES TM'S PAGE FOR INSPECTOR USE ONLY I'INAL INSPECTION NoTEc Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT fE PLAN REVIEW NOTES