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HomeMy WebLinkAboutG-14-625 �_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK IS CITY YARMOUTH , MA. DATE 12117113 PERMIT# bi'l-&2 JOBSITE ADDRESS 37 ANASTASIA ROAD OWNER'S NAME KAROL GOWNER ADDRESS: WEST YARMOUTH TEL: 508-790-1153 FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL❑ti PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO LI FIXUTRES 1 FLOOR—. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER x FIREPLACE FRYOLATOR ' FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER EBF s -1 INSURANCE COVERAGE nor Y'I),j I have a current liability insurance policy or its substantial equivalent which meets the requirements of MG .14V YES L. NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. BUILD:NGtE T l 27 LIABILITY INSURANCE POLICY I] OTHER TYPE INDEMNITY 0 "613(101:r N1:_ 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT 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. ot_e dad . PLUMBERIGASFITTER NAME LEON E CLARK,JR. UCENSE# 11734-M SIGNATURE ' COMPANY NAME: TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE CITY: SOUTH DENNIS STATE: m ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL 508-367-1451 EMAIL' MASTER ) JOURNEYMAN 0 LP INSTALLER 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# r L t !7 f 18 Atlantic Avenue South Dennis,Ma.02660 (508)385-8868 TC TYNDALL & CLARK PLUMBING AND HEATING CO, INC. January 24, 2014 " 7 is R Town of Yarmouth r' R 1146 Route 28 t t R J South Yarmouth, MA 02664RTMENT BUILUINU�L' n RE: Gas permit for 37 Anastasia Road West Yarmouth Lee Hall, Plumbing and gas inspector, We would like to cancel our gas permit dated 12/17/2013#G14-625 for the installation of a gas dryer for Karen Karol at 37 Anastasia Road in West Yarmouth. Ms. Karol is no longer going to have us install this for her. Thank you for your help in this matter. Thank you, Kathy Morrison Business Manager TC Tyndall and Clark Plumbing and Heating Co., Inc. RECEIVED JAN 282014 BUILDING DEPARTMENT MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK y`Z Stir / CITY YARMOUTH MA. DATE 12117113 PERMIT# b//(—��5— J OBSITE — JOBSITE ADDRESS 37 ANASTASIA ROAD OWNER'S NAME KAROL OWNER ADDRESS: WEST YARMOUTH TEL: 508-790-1153 FM: TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL ri❑ PRINT CLEARLY NEW:0 RENOVATION: © REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 FIXUTRES 1 FLOOR—. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER x FIREPLACE . , FRYOLATOR FURNACE —_ _.-- GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN • POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER ilS INSURANCE COVERAGE l !� r I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL:Ch.142 YES ❑t NO 0 If you have checked YES please indicate the type of coverage by checking the appropriate box below. C''--; °;" 4 LIABILITY INSURANCE POLICY ❑M OTHER TYPE INDEMNITY 0 :100 ■ .1 d4 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 0 SIGNATURE OF OWNER OR AGENT 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. . e �e2 PLUMBERIGASFITTER NAME: LEONE CLARK,JR. LICENSE# 11734-M SIGNATURE COMPANY NAME: TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE CITY: SOUTH DENNIS STATE: Q ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL: 508-367-1451 EMAIL: MASTER❑] JOURNEYMAN 0 LP INSTALLER 0 CORPORATION 0# PARTNERSHIP❑# LLC❑# y n