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Home My WebLink AboutBLDG-23-005076 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0-- r CITY YARMOUTH MA DATE March 15,2023 PERMIT# BLDG-23-005076 JOBSITE ADDRESS 60 BROADWAY UNIT 15 OWNER'S NAME KENNETH CATALDO G OWNER ADDRESS 25 OLYMPIA AVE WOBURN 01801-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO El 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/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 © NO El 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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL EMAIL stinger.mcbrideta7.4mail.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 irMQ `v` �"j CITY II��5 �✓'m 0ell MA DATE fe) /? F., PE410G'Z 3—60SQ O/1/ pl5fJu€ k OWNER'S NAME l7'/'i / (G JOESITE,4DDRESS Z J� �^- ' ,7 OWNER ADDRESS Wd ham eiTe / 7DEL/r/ 275-- FAX T fErP� O) e co-,-;::, w y r- eltiPRIN')! „FFsE o eifo M� CI vEDUCA IONAL ❑ ! ' R IDENTIAL'❑ CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:Vi PLANS SUBMITTED: YES 7 NG❑ APPLIANCES 1 FLOORS-4. BSIv1 1 2 3 4 5 6 7 8 9 10 11 12 13 LL BOILER BOOSTER CONVERSION BURNER _ _ COOK STOVE _ DIRECT VENT HEATER _J DRYER FIREPLACE FRYOLATOR FURNACE --, - GENERATOR } • GRILLE INFRARED HEATER. LABORATORY COCKS . MAKEUP AIR UNIT OVEN i POOL HEATER • I ROOM I SPACE HEATER ROOF TOP UNIT ; R E C E I V E 3 TEST ... UNIT HEATER UNVENTED ROOM HEATER — MAR 13 2023 1 WATER HEATER 0 /0 a OTHER BUILDING DEPARTMENT.] — �7 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ik/1 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY N 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 "t-• 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 LICENSE tr SIGNATURE MP ❑ MGF❑ JP [X JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC CII • / COMPANY NAME Cf / �i'/ ADDRESS CITY STATE ZIP TEL FAX CELL EMAIL Ch as°1 (1) ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • • FEE: $ PERMIT ft PLAN REVIEW NOTES • • • L.