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Home My WebLink AboutBLDG-23-002619 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK as CITY YARMOUTH MA DATE November 10,202: PERMIT# BLDG-23-002619 JOBSITE ADDRESS 1 MAUSHOPS PATH OWNERS NAME KENNEDY AGNES M(LIFE EST) G OWNER ADDRESS IC/0 JOANNE M KENNEDY 1 MAUSHOPS PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 1 FRYOLATOR FURNACE . GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS . MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER . ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 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 El 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 'Andrew Leighton I LICENSE# 16130 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IANDREW R LEIGHTON ADDRESS. 120 Brewster Rd, CITY W Yarmouth STATE MA ZIP 026735706 TEL I FAX CELL I EMAIL lhalloilcompanvAgmail.com S60 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -Y-�ff 1-=fM_if =ut >' CITY / Q _ MA DATE:Tr p..d`l PERMIT# - 7 JOBSITE ADDRESS Qop, p I OWNER'S NAME r 3 OA4_(,[„one _ G -- , --- OWNER ADDRESS T�� ^� G Cc/�1F - TYPEOR OCCUPANCY TYPE COMMERCIALQ EDUCATIONAL PRINT ID RESIDENTIAL t.}� CLEARLY NEW: RENOVATION:Li REPLACEMENT:Li PLANS SUBMITTED: YESO NO APPLIANCES 1 FLOORS-, 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ;' _ k t..- t' BOOSTER '-__- �..,. _ _ CONVERSION BURNER = '�` E -f-=_ COOK STOVE 1 - -Maiaii -- --•' ._--_ �-- DIRECT VENT HEATER l ' - ' , ,2 ,gine.r= M1 DRYER ! .I : _._- FIREPLACE FIREPLA OR = mi. ; g FURNACE _ _� — i y�._ >' i'I,_---r' 1w. t GENERATOR ;V • " �� •- - (�ir`( ., 3 �` GRILLE lia- - 111 V ' i. INFRARED HEATER " I _". LABORATORY COCKS -ro.nouniarnylizattliff MAKEUP AIR UNIT • 1 iOVEN - `_' '� .l POOL HEATER f. - , man ROOM/SPACE HEATER =- i�.„I ROOF TOP UNiT 5 TEST2..._ 1 ,nw.„_,_ i UNIT HEATER ` . :� UNVENTED ROOM HEATER . • - " i WATER HEATER '� i i , OTHER .M..„ F. _ - - ts,„„.._ k } 1 1 {{ _ _ _, ,,,___„`1 1— I ,... f. , ._,_.,.v= _,i _ .,® ' . �,f INSURANCE COVERAGE � i have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �--, E I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I LIABILITY INSURANCE POLICY U OTHER TYPE INDEMNITY El BOND El I OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT L i hereby certify that all of the details and Information i have submitted or entered regarding this applicati•- are tru=and - cure : o the•'at of my knowledge and that all plumbing work and installations performed under the permit issued for this application will .e in corn•ianc-with. Pertin= t provision of the , Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r f PLUMBER-GASFITTER NAME[¢d!d/?et e2 sr: -r 6-€izU Y_ LICENSE#era SIGNATURE MP B MGF 0 JP Q JGF® LPG!Li CORPORATION #r3)3y C__PARTNERSHIP I__-J# LLC LI# T COMPANY NAME: © fij;� :f��C . �c_C6 _zi�Pe-. ..... ADDRESS �3� �..� 3fr' , . .� � _ _ - - .._... ._-.,__ i Si2, ,.1 CITY , 3._5_-._,.,_________.._ _,._. I STATE 17,29 ZIP QQ.b6C ._JTEL 22 2.21?�.._7_3$3 1 ..r.._9 FAX ESP -f CELL_ _... EMAILLh ilQz4' ._c ,_ 5?"-,(4,/9/.:if C- _. .-.