HomeMy WebLinkAboutBLDP-20-002892 (2) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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=- YARMOUTH 11/14/19
Ia_ CITY MA DATE PERMIT#,l-0-90-11"0 agFQ
JOBSITE ADDRESS 19 AURORA LANE OWNER'S NAME JIM WALSH
GOWNER ADDRESS SAME TEL 508 760 2174 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL❑■
PRINT
CLEARLY NEW:❑ RENOVATION: El REPLACEMENT: 0 PLANS SUBMITTED: YES El NO 0
APPLIANCES 1 FLOORS-0 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
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 1
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ID NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑� OTHER TYPE INDEMNITY El BOND El
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 El 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 accurate to the est f my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp is with all Perti t pr .sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME DOUG LANGTRY LICENSE# 11305 N URE
MP❑■ MGF 0 JP El JGF 0 LPGI El CORPORATION El# PARTNERSHIP El# LL ❑■ # 3081
COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28
CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-619-3367
FAX 508-619-3367 CELL EMAIL DOUG-AQUA@COMCAST.NET
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ El
FEE: $ PERMIT# v
PLAN REVIEW NOTES / ! /7 // /?