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Home My WebLink AboutBLDG-22-001450 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e ,=6 CITY YARMOUTHikt,t MA DATE September 14,202 PERMIT# BLDG-22-001450 JOBSITE ADDRESS 14 ANGUS AVE OWNER'S NAME TY MACK CORP G OWNER ADDRESS MA 02333-1809 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 1 POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER 1 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 0 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 Chris Lafrance LICENSE# 26347 SIGNATURE MP❑ MGF 0 JP 0 JGF 0 LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: CHRIS J LAFRANCE ADDRESS. 36 OLD MAIN ST, CITY S YARMOUTH STATE MA ZIP 026645645 TEL FAX CELL EMAIL lafrance1012qmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No Peed prGpi S4r K 11I11N THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ pro �tun Fey C SST MO FEE: $ PERMIT# 1 PLAN REVIEW NOTES ' RECEIVED $80,0 SEP i 3 2021 8;ACHUSETil UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS nrnNe WORK 11 .-1.7';:--• f-Aid.4 kii47:009- 3 _ , /AA "Cri Ili,--A Mk DATE 9/i 3 iz- I PERMIT# 71-14 Cli '1/4":7-1-51— — • - If (Y1 JOBSITE ADDRESS: 1 4-1 /4111 ti,‹ OWNER'S NAME ill, G OWNER ADDRESS; TEL FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL E3 EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEWtgLRENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES&NO 0 APPLIANCE81 FLOOR-0 Bemt 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 7< GENERATOR GRILLE s.,, . . Si) INFRARED HEATER ' t2 LABORATORY COCK ..., MAKEUP AR UNIT s.1 OVEN POOL HEATER >.. , - ROOM I SPACE HEATER f N -4 ROOF TOP UNIT '.0zZ TEST UNIT HEATER - - . tu UNVENTED ROOM_HEATER WATER HEATER >- . . _ , . . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL at.142 YES cg NO 0 If you have checked na,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY tg. OTHER TYPE INDEMNITY El BOND 0 OWNER'S INSURANCE WAIVER I am aware that the licensee ilgesgabege 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 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this appication are true and accurate to the beet of my Knowledge and that all plumbing work and installations performed under the pent*issued for this application all Pertinent provision of the Massachusetts State.PI ing Zand/Gilapter 142 of the General Laws. PLUMBERIGASFITIER NAME: NY',5 1-rdolce..._ LICENSE#01M/2 TURE COMPANY NAME: C 'k..5- i•----;;4',-'e__-. 7)7,../mit",9Li ADDRESS: Y 6 00 i'll )9-1 Al C / CITY:6. 4-Vfme./A STATE: 4//2- MP: ri", ZK-,>4-, FAX TEL: cat.: 505 -36 if/666 EMAIL: 16--rr "-c--e— IQ 1 a 60.,-)14/.). ‘L)i''' MASTER 0 JOURNEYMAN1A LP INSTALLER D CORPORATION 0# PARTNERSHIP 0# LI.PIK1# E hm i c ADDiteS 5: