HomeMy WebLinkAboutBLDG-20-002942 \.' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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TYPE OR
PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ,,u RESIDENTIAL;
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NEW: RENOVATION: ,,,, REPLACEMENT:i„„j PLANS SUBMITTED: YES;,,,; NOrr,
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CONVERSION BURNER � �
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INSURANCE COVERAGE
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I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1„,/,, NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1,f o OTHER TYPE INDEMNITY —,A BOND i„r,,,
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 1_„„j 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 best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with ail Pert' nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Sean Hanrahan LICENSE# 15822 j SIGNATURE
MP ,',1 MG F ,,,,H,u J P J G F PG I ,J CORPORATION i ,j#i PARTNERSHIP r,,,,,, # I LLC J#
COMPANY NAME:;Sean Hanrahan Plumbing and Heating_ ADDRESS PO BOX 688
CITY 'Centerville j STATE, MA ZIP,02632y,,,,,,, �TEL[774-238-0286
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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 ❑ ❑
FEE: $ PERMIT# 4. OP'(
PLAN REVIEW NOTES 1E>4 1/ /Vi
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APPLICATION FOR PERMIT
City or Town: Yarmouth
Date: 11/14/2019
Permit Number: 102544
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 102 BREEZY POINT ROAD/South Yarmouth, MA 02664
For permission to: Unvented Gas Heater Installation 527CMR 1.12.8.6
Name of Competent Operator: Joseph Luciano Cert. No.
Date Issued-Rejected 11/14/2019 By `;"fr'''-'7..4
(Signature of applicant)
Date of Expiration: Fee: $50.00 $ Paid Due
171
BREEn4
-.-- YFD
96 Old Main Street
South Yarmouth, ma 02664
508-398-2212
Receipt for cash or check
Primary Contact: Occupancy:
Breezy Point Rd 102
102 BREEZY POINT ROAD
South Yarmouth, MA 02664
Joseph Luciano
Permit # Type Issued Effective Expires Fee
102544 Unvented Gas Heater Installation 11/14/2019 11/14/2019 $50.00
527CMR 1. 12.8. 6
Check Number: 3 75—( Total Fee $50.00
Cash Received by:
Special conditions of issue:
(1) A permit shall be obtained from the head of the fire department and the
local or state gas inspector having jurisdiction for the installation of all
unvented propane or natural gas-fired space heaters.
11/14/2019 15:55 Page 1
Home •> Division of Professional Licensure > Board of Registration of Plumbers and Gas Fitters >
Accepted Pluming Products Online System
By the Division of Professional Licensure
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Search Criteria. `
Type: Gas
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Manufacturer: Empire Comfort ;� ,,, ,� 4;
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Description:
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`EMPIRE Empire Comfort G3-1018-
UNVENTED ROOM HEATER Systems, Inc SR18 2/3/2016 103
EMPIRE Empire Comfort G3-1018-
I UNVENTED ROOM HEATER
'SR18T 2/3/2016
Systems, Inc 103
.EMPIRE �T7 Empire Comfort � SR18W, G1 0119
;UNVENTED ROOM HEATER white Systems, Inc TW (1-99) 1/2/2019 ;288
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Unvented Gas Log Heater or Vented Empire Comfort Name: G3 0317
Decorative Appliance
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Model:
VFSR 18-4
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