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HomeMy WebLinkAboutBLDG-23-000376 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE July 25,2022 PERMIT# BLDG-23-000376 • JOBSITE ADDRESS 128 CAPT WRIGHT RD OWNER'S NAME GORDON NARDIA L G OWNER ADDRESS 28 CAPT WRIGHT RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL GO 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 1 BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER 1 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 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 0 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 Robert Allison LICENSE# 15353 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ROBERT E ALLISON ADDRESS. 182 LAKE SHORE DR, CITY EAST FALMOUTH STATE MA ZIP 025364792 TEL FAX CELL r EMAIL bill(aathefuelcompany.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 p. eke j- � �.�.�m�- ___ MA DATE! PERMIT# =�t1� CITY `�G�rnc��1 ,y __ OWNER'S NAME i 1- ' C�JOBSITE ADDRESS C ' ; �,,J;`� _ I MCA C l►f _ ` ,G .,.. ,. OWNER ADDRESS D 8 Ct -l- a�. AY 9hk_,'?COt.. _ TEI 114-, 4-' `k4 FAX 1 TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL j CLEARLY NEW:[� RENOVATION: REPLACEMENT:1, , PLANS SUBMITTED: YES Li NO APPLIANCES 7 FLOORS-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER r... ,'°, -- r-`-_ __ ..` _ . - . .... ,:.u ._. . ._- _- 1 _. BOOSTER °— r ,-1_.,. ,. . ,� . ''., -71 . _. . ._ i . r CONVERSION BURNER i° ' I COOK STOVE ' X .._ I _I ..I- I 1 DIRECT VENT HEATER ! '; g`. .., ,...,. , . r ., DRYER FIREPLACE i . { 4 FRYOLATOR r sl .. ;� i . I, ,...... I--., s --ili FURNACE GENERATOR GRILLE i E .1_. I- , ' ._. . L . . MI INFRARED HEATER 1 :� 4, l � 71,. 1illt i LABORATORY COCKS `� MAKEUP AIR UNIT i 4 I °' I 7- l i OVEN 1 B;, „ .�.1' : ., ,L I,_'. II ii POOL HEATER .:,...-I- I• _ . . _ .. _ i ROOM/SPACE HEATER ' �W i r. . r ' . .-1 -11---, - ,._, ,. .a_ „�, _raw. ,.r,. , ri ROOF TOP UNIT I1 '1 TEST UNIT HEATER €° UNVENTED ROOM HEATER ri 1 _r.. il ,i i ( z.3..w- sa� �:.b �p r rw� ��-�� wl�'-� v�•�►tr:`r x� n. . �- . WATER HEATER 1 • I.:. . �... , 1 i _ OTHER . iI ...... _, V 11.. 1 II 11 11 II 1 s . ' . _ ��, . ._ !_.. _IL d r . _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO Li I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [Xi OTHER TYPE INDEMNITY n 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 0 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 a i'• u 1 to to th best o edge and that all plumbing work and installations performed under the permit issued for this application will be in complianc •,ith - P-rti r oft e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME • i o AS I LICENSE#1153S?j SIGNATURE MP MGF X JPLI JGF 71 LPG!I CORPORATION( #; PARTNERSHIP LC #I COMPANY NAME:[ ��L .•(7,i4f4 AA. , 'ADDRESS, /// 24e Z8 CITY 1._f 7 v / STATE 1 ' ZIP; O�,S3 TEL j S' k ,5 � 7 'o FAX ,8 3 ‘,3ej CELL a'5.27'/J'S74EMAIL! sji //62 'j% .�'c/-c( d,�,,, _ gt, e * % , .11 ; ft 4 411/4 4 4'