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HomeMy WebLinkAboutBLDG-21-005388 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11/4 M' CITY YARMOUTH MA DATE March 19,2021 PERMIT# BLDG-21-005388 JOBSITE ADDRESS 28 ACADIA RD OWNER'S NAME living independently forever inc G OWNER ADDRESS P 0 BOX 3 WEST DENNIS MA 02670 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El 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 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 0 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 Gary Famigliette LICENSE# 10191 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: GARY FAMIGLIETTE ADDRESS. 67 MAPLE AVE, CITY HYANNIS STATE MA ZIP 026014403 TEL FAX CELL EMAIL FAMCO a@COMCAST.NET 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 y ' CITY�r.Yl.3. . M _r_ i�. ,, -.,�. -- MA DATE +�PERMIT# 1L O G- JOBSITE ADDRESS' 42 r �c'C,,, ... I OWNER'S NAME ' L iv,6,5 F.^ ,",.,44.) cr1re,- Tn 4- GOWNER ADDRESS i ^ _ - { ._ -.,,T ��TEL FAX E TYPE OR OCCUPANCY TYPE COMMERCIAL;..( EDUCATIONAL RESIDENTIAI,V, PRINT CLEARLY NEW:J RENOVATION:3 REPLACEMENT:Irr PLANS SUBMITTED: YES 1 N0 i APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER J _ . . I __._J. . BOOSTER :. _ �J . -J` _._J • i.____I CONVERSION BURNER i __I ____I ,.I•__1 COOK STOVE _____.1 '______I ___.J• _J DIRECT VENT HEATER _I -J _J _J: _.i,,,_.J DRYER• -. + - .... _J __)___I - ..... FIREPLACE .- I i �.J_! •. ____I._! .�J..__j j FRYOLATOR `� J FURNACE .-- -" 'a. ,� • —J-- . . --- -1-- I ! ____J___J - —I_I ...1_ J_-I HEATERI GENERATOR GRILLE INFRARED .__j .•- •- • _ __I __1___1—i to MAKEUP AIR UNIT — ____LI - -- - _____/____I _J_J_J • • ==_J __J_J__j POOL HEATER ROOM/SPACE HEATER Li„ MitI _„J I 1 ..,:.:1 I 1___I ROOF TOP UNIT ._._..J __�_I___I.__J • ._1_.T..i ...LiTEST - - - .a..,-! _ _J _ UNIT HEATER ! --_ - I _ ,J - -- _ UNVENTED ROOM HEATER • __j I _--__i _�_J__ ..i—I,•_j —1...._J _.1WATER HEATER -- --___..._ -r--I r-- ---r-1--I L J----I_J-r_. , -t-r ,J- I-- .,I--,-1 ---1__ _I_____J I,--J --..----1.--I ' . . 0711E111,. -. 1-s--! - I• i s- 1.--1 _J-,----1---I'--j r,r�I:r--s� --, L. I „...„,1I c-rti- ----J::,L j. I --i r�--J -_.._.i .-r-J .... „r- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES IX NO t I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY .J 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. CHECK ONE ONLY: OWNER ,'J 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 to to the best of my knowledge and that al plumbing work and installations performed under the permit issued for this application will be in corn al Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ( -,,A,x GA+ �UCENSE#JO/Q C SIGNATURE MP MGF 1 JP 3 JGF j LPGI 2 CORPORATION'�#` j PARTNERSHIP:.,_!#: LLC J#;___„_:___I COMPANY NAME: I►�I p ---------4---- --------._ — - - --_. .- .--_...._-._.....___ ADDRESS l ` . . I. CITY 4�,�, .. .._ 5.. . ._... . .. . .. I STATE, I ZIP a266 C ITEL 3'd�'- 77, spa FAX I CELL; EMAIL.. . �_�CO �y/'�C� '1f-, liGto