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HomeMy WebLinkAboutBLDG-22-000616 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '' CITY 'YARMOUTH MA DATE August 03,2021 PERMIT# BLDP-22-000616 JOBSITE ADDRESS 56 HASTING AVE OWNER'S NAME CONNOR KERRY JAY G OWNER ADDRESS CONNOR MARTHA A 17 FOX HILL DR WESTFIELD MA 01085 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES 0 NO FIXTURES 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 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY 0 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. 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 LEON CLARK,JR LICENSE# 11734 SIGNATURE MP© MGF ❑ JP❑ JGF 0 LPG( 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ITC TYNDALL&CLARK PLUMBING&HEAT ADDRESS. 118 ATLATNIC AVE, CITY 'SOUTH DENNIS STATE MA ZIP 02660 TEL 15083858868 FAX CELL EMAIL I v S310N M3IA32i NV1d #.MW J3d $:33d El 0 llINted NI SV SSAtI3S NOIlVOIlda SIHI oN seA S310N NOI103dSNI 1VNId KINO 3Sfl b0103dSNI 2i0d 3OVd SIHl S310N NOI103dSNI SVO HOf10b