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Home My WebLink AboutG-14-813 t ' ' _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =r 7.>/e/-217‘_/ / p�/� vµ�tc�t CITY Yarmouth / $ ! MA DATE March 3,2014 1 PERMIT# LY/0 7J _ F JOBSITE ADDRESS 21 Lake Road_(West Yarmouth) I OWNER'S NAME O'Donnell I GOWNER ADDRESS 22AudreysLane I TEL 508-280-8490 {FAX 1 qTYPE OR OCCUPANCY TYPE COMMERCIAL J EDUCATIONAL J RESIDENTIAL 1.1 PRINT 1` CLEARLY NEW:+1 RENOVATION: J REPLACEMENT: J PLANS SUBMITTED: YES J NO J APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 1 6 7 i 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER __-_..1 COOK STOVE ' r DIRECT VENT HEATER _ DRYER FIREPLACE : : : _. ...._! ! _'c- _._._! - .__..__! _ ' . ... ..-_.._.! s FRYOLATOR FURNACE ! GENERATOR ! ---- .J ._._ ..! GRILLE : _.._ 1 I ' - INFRARED HEATER LABORATORY COCKS ! ' .—.__� ! _._._._ —_-'' MAKEUP AIR UNIT OVEN POOL HEATER ' .._ 1 ! __... ' ROOM I SPACE HEATER ! ! ----: ! i_ ! -— ' ._ ' : ! I ' ROOF TOP UNIT —_ TEST X : , UNIT HEATER ' , ' _ ,_ r - ! _ _ ' UNVENTED ROOM HEATER WATER HEATER OTHER ; I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES H J NO J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J OTHER TYPE INDEMNITY J BOND IJ 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: 0 ER J AGENT J SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appli ion are e and acwrrr1��'iii'pppp�e e best of m knowledge and that all plumbing work and Installations performed under the permit issued for this application will In con lac, with alLP i e rovisio of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 11 PLUMBER-GASFITTER NAME Christopher L Menslage (,LICENSE# 3871 I SIGNA E MP _1 MGF 11 JP J JGF J LPG! J CORPORATION J# I PARTNERSHIP J# I LLC J# COMPANY NAME: All Gas Heating&Cooling,Inc. I ADDRESS 15 Jan Sebastian Drive B2 1 CITY Sandwich I STATE MA I ZIP 02563 1 . 8E33 8 ED- FAX 508.833.7588 I CELL 508-274-0831 (EMAIL info_©allgasheatcom I 1AR-M 20{11k • s; /�1+plIQ9...EPTRP —T lie fl Psi) in rfreor - ' .