HomeMy WebLinkAboutBldg-20-002313 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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1-h CITY I YARMOUTH ,� MA DATE'10/23/2019 PERMIT#*/76 2d - .'3/3
JOBSITE ADDRESS`67 ADAMS RD � „m � , OWNER'S NAMEHARMONY JUDY
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TYPE OR OCCUPANCY TYPE COMMERCIAL�, ,.....,_EDUCATIONAL RESIDENTIAL
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NEW: RENOVATION: „„„/J REPLACEMENT:iy; PLANS SUBMITTED: YES;,,,,,,%; NO,,,u„
APPLIANCES-1 FLOORS—. BSM 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14
BOILER 1 ioi
BOOSTER sr II II 71
CONVERSION BURNER
COOK STOVE Antsousior ,, int,
DIRECT VENT HEATER
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DRYER I ,e 4 6=_
FIREPLACE Im
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FRYOLATOR
FURNACE � ....
GENERATOR 4
GRILLE
INFRARED HEATER I,r.—TlIllr.srirootssieiumsit umummusI
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LABORATORY COCKS d� 111
MAKEUP AIR UNIT ._ ' M.
OVEN ,4
POOL HEATER i 0
ROOM/SPACE HEATER __ , � , __ I
ROOF TOP UNIT I
UNIT HEATER
UNVENTED ROOM HEATER
WATER IL-110:10“....trailrjamitillilimilial= 111.1111411400.10,11
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ll NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 4„, 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 ,,,,w AGENT iN,,,
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 I Sean Hanrahan , LICENSE th 15822 SIGNATURE
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MG F 4 JP JGF , LPGI',,,,,u, CORPORATION , # ,,,,,,,,,,,,,,,,,,,,, ,,
PARTNERSHIP # , LLC , s#
COMPANY NAME:,Sean Hanrahan Plumbing and Heating �� ADDRESS PO BOX 688
CITY Centerville I STATE I MA I ZIP 02632 %TE I 48ti,. ,,, „H, ,,,,,H,,,H
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FAX,508-775-4615�„ CELL'same y EMAIL hanrahanplumbin mail.com �� , _ t
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
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FEE: NoTHIS APPLICATION SERVES AS THE PERMIT$ PERMIT# /l�`' 7L /® /7 L
PLAN REVIEW NOTES