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HomeMy WebLinkAboutBLDG-23-005707 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK h CITY (YARMOUTH kr, MA DATE (April 13,2023 PERMIT# BLDG-23-005707 JOBSITE ADDRESS 139 OUT OF BOUNDS DR OWNER'S NAME IMEANY MICHAEL J TRS G OWNER ADDRESS MEANY HELEN TRS 39 OUT OF BOUNDS DR SOUTH YARMOUTH MA 02664 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT PLANS SUBMITTED: YES El NO❑ CLEARLY NEW: ElRENOVATION:❑ REPLACEMENT:DI _FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 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 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❑ 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 (Anson Celin 'LICENSE# 132655 I SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPG( ❑ CORPORATION❑#I I PARTNERSHIP ❑#1 ILLC ❑#1 I ADDRESS. 126 Capt.Blount Rd, I COMPANY NAME: IANSON CELIN I CITY (South Yarmouth 'STATE IMA I ZIP 102664 I TEL I I FAX I I CELL 1 1 EMAIL Iansoncelin aC2vahoo.com 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK —. CITY ,./t{ii ut or"cx MA DATE L---( '2. PERMIT# C.. " c-70) JOBSITE ADDRESS `3.1 0CAA e;( g6,ndc• Dr OWNERS NAME y_ OWNER ADDRESS 31 O 4 (3 ,,h- 0, TEL (7/`7'2-1i2—?1 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL C47- PRINT CLEARLY NEW:❑ RENOVATION: 11 REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO S i APPLIANCES 1FLOORS-► BSlul 2 3 a 5 s 7 8 s 10 11 12 1 i t� i BOILER BOOSTER ' CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER f FIREPLACE I FRYOLATOR FURNACE GENERATOR GRILLE 7 L _. INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST ..-._.. -- UNIT HEATER INVENTED ROOM HEATER • WATER HEATER OTHER _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [2NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE- E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ! 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 0 AGENT 0 ;� SIGNATURE OF OWNER OR AGENT 4, 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 `k- and that all plumbing work and installations perfomied under the permit issued for this application will be in co ance with all Pertinent provision of the � ,. Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` PLUMBER-GASFITTER NAM- LICENSE#qSS SIGNATURE ❑MGF JP Nor GF 0 LPGI 0 CORPORATION 0# PARTNERSHIP El# LLC 0# MP❑ COMPANY NAME Ce I ii) `ifm?4,%y� ADDRESS 24 G ¢G; a kke)1 k(eD CITY %v 6 (Ithmairrh STATE 44A ZIP 6.4 TEL FAX CELL 514-2 2C(a-47GL EMAIL 61(eh"-,?yJ• C04,