HomeMy WebLinkAboutBldg-19-006408 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY
YARMOUTH
MA DATE 5/13/2019
PERMIT#I -jv%!,o ,ram 69 /0 38 DANBURY STREET KEVIN DRISCOLL
JOBSITE ADDRESS OWNER'S NAME
GOWNER ADDRESS TEL 508-631-5908 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑■
PRINT
CLEARLY NEW:❑ RENOVATION: ❑■ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO 0
APPLIANCES Z 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 1
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST YIP j )11
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑■ NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑■ OTHER TYPE 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.
CHECK ONE ONLY: OWNER ❑ 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 and accurat o the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in c ce with a rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME DOUG LANGTRY LICENSE# 11305 S NATURE
MP❑■ MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION❑# PARTNERSHIP❑# LLC❑■ # 3081
COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28
CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367
FAX 774-470-1351 CELL EMAIL DOUG-AQUA@COMCAST.NET
1,/e/1 CL-11-t3tD ��
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
AM 6/ ei/ FEE: $ PERMIT# i' v-- zL n /
0(---( :37/Q//7 PLAN REVIEW NOTES , ?27)