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Home My WebLink AboutBLDG-22-001165 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK � rl' CITY YARMOUTH MA DATE August 31,2021 PERMIT# BLDG-22-001165 JOBSITE ADDRESS 54 BOXBERRY LN OWNER'S NAME Arthur Jones G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 Carlos Daveiga LICENSE# 5146 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: CARLOS DAVEIGA ADDRESS. 11 STONEY RD, CITY W BRIDGEWATER STATE MA ZIP 023791112 TEL FAX CELL EMAIL artieiones123 angmail.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 � h 1.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Yot�IYlO(J'(�CITY: pp MA DATE /24 PERMIT# f7 JOBSITE ADDRESS: 5"1 Obf/1 Jn OWNER'S NAME 1t,1 i vv d aji-e c OWNER ADDRESS; 5 S ox b er✓ TEL: �D I -D 3-Ed FAX: G y y 7 TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL Q -. PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:Q- PLANS SUBMITTED: YES 0 NO li APPLIANCESZ FLOOR-. Bawd 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 _ VLu INFRARED HEATER , LABORATORY COCK _ MAKEUP AIR UNIT , �3 OVEN i - POOL HEATER p ROOM/SPACE HEATER 7.4 ROOF TOP UNIT Q TEST , •Z UNIT HEATER t,U UNVENTED ROAM HEATER WATER HEATER IIRANCE COVERAGE �.,/ I have a current jiaWlity instaance policy or its substantial equivalent which meets the requirements of MGL CFh.142 YES 0 NO lJ If you have checked ,please Indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 BOIL 0 OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the Insurance coverage required by Charter 142 of the Massachusetts General Laws,and that my signature on this permit application skin this requirement CHECK ONE ONLY: OWNER [AGENT 0 SIG LIRE NT hereby oerety that all of the details and information I have submitted(or entered)regarding this appication are true and accurate to the best of my Knowledge and that all plumbing work and Gins performed under the permit issued for tie application wM be in compliame wli all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 rite General Laws. ra* PLUMBER/GASFITTERNAME; Ca(lo S DMitt TA LICENSE#,5 I LIU "; GNA COMPANY NAME; ADDRESS: I(Q A-(d f l CO 40( CITY: wee{- 6rid9Q1 i(*t STATE: MA ZIP 02b1°I FAX; TEL: CELL: &l- S 1 - 93 I- 63 EMAIL I IT MASTER 0 JOURNEYMAN[r LP INSTALLER❑ CORPORATION 0# PARTNERSHIP 0# LLC ..s` O 21 Emmq. 09-agess: ay fie,SOws t.2,3 a 56160( • eteir _ BY ao 0 46 E