Loading...
HomeMy WebLinkAboutBLDP-23-005804 (2) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH MA DATE April 19,2023 PERMIT# BLDP-23-005804 JOBSITE ADDRESS 148 WINTER ST OWNER'S NAME CONTI RICHARD D G OWNER ADDRESS CONTI MARCIA 48 WINTER ST YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:ID 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 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND 0 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 (Kevin Mcbride LICENSE# 111620 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION El# PARTNERSHIP El# LLC ❑# COMPANY NAME: IKEVIN J MCBRIDE ADDRESS. 111 COCHESET PATH, CITY IWEST YARMOUTH STATE MA ZIP 1026732559 TEL I FAX I I CELL 1 I EMAIL Ikmcplumb(a).comcasLnet ,-;.. E 1 TE81514USEITS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Yorfoc.k.)-gpor-+ MA. DATE: 4/ff 1d3 PERMIT#P23 5-gc9L1 ---17 a R 1J01.414i1DD ES3: 4i W:A-1,r OWNER'S NAME /2.(1(1 r ii4 B. DING DOWNER- TELCs k)"I 37-0 19 FAX: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL k, PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES 0 NO APPLIANCES1 FLOOR—, Bent 1 2 3 4 5 6 _7 8 9 10 11 12 13 14 BOILER s, "-' BOOSTER CONVERSION BURNER ci• COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR \J FURNACE GENERATOR GRILLE VI INFRARED HEATER Jl LABORATORY COCK MAKEUP AIR uNIT SZ OVEN _ POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT it TEST UNIT HEATER r4.4 UNVENTED ROOM HEATER WATER HEATER I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESTZ.NO if you have checked YES,please Indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY I:21" OTHER TYPE INDEMNITY El BOND 0 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 a AGENT SIGNATURE OF OWNER OR AGENT 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 win be In corm. with an Pertinent provision of the Massachusetts State Piunting Code and Chapter 142 of the General Laws. 0-40 PLUMBERI(ASFITTER NAME: IT) c LICENSE# II is.;i0 SIGNATURE COMPANY NAME:Ve-y. (Y)cer,(-1 e, P --rmr. ADDRESS: it (34-Ji e-1 Pc4 CITY: W.Yri fro STATE: r4 ZIP: Og 7 3 FAX: TEL:(5_OS) e- CELL 0/17) 34.4^ 7;14 EMAIL [phi 1/1 MASTER 12rJOURNEYMAN 0 LP INSTALLER': CORPORATION Er# Fa PARTNERSHIP 0# LLC D# N)Dite-SS (11,1D