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HomeMy WebLinkAboutBLDG-23-004744 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' 74 ,� CITY (YARMOUTH MA DATE IFebruary 27,2023 I PERMIT# BLDG-23-004744 JOBSITE ADDRESS 14 RUNE STONE RD I OWNER'S NAME Isheila reilly G OWNER ADDRESS 4 RUNE STONE ROAD SOUTH YARMOUTH MA 02664-1325 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT PLANS SUBMITTED: YES CI NO CI NEW: IIIRENOVATION:❑ REPLACEMENT:CI 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 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 ILESTER WADE 'LICENSE# 14569 I SIGNATURE MPMGF © JP 0 JGF 0 LPGI 0 CORPORATION❑#I I PARTNERSHIP ❑#1 ILLC 0#I I 0I COMPANY NAME: ILESTER J WADE I ADDRESS. 122 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD I CITY COTUIT STATE IMA I ZIP 1026352702 I TEL I I FAX CELL EMAIL linfo(7a,cciogenerators.com • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK y �{Li.+rwA o L.t.+t► MA DATE R--t a -2- a- PERMIT* 7-3- (-1-7 y 6( JOBSFFE ADDRESS `( c.v ve S-f o tie. R OWNER'S NAME Sly e (a 12 ,`fG I y OWNER ADDRESS SIC. O OVA Ta t. -aot-sis-oO FAX PPJNT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CY 'NEW:1I RENOVATION:Q REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 21 APPLIANCES Z FLOORS-' NM 1 2 3 4 5 6 7 8 9 10 11 i2 13 14 DICER BOOSTER CONVERSION • COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ( MAKEUP AIR UNIT OVEN POOl.HEATER ROOM SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current lability insurance policy or its equivalent ash meets the requirements of MGI.Ch.142 YES ® NO 0 I FYOU CHECKED YES,PLEASE IGATI:THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITYINSURANCE POLICY (g] OTHER TYPES 0 BONDOWNER' ❑ S INSURANCE WAIVE R 1 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 perms application ohm this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY OWIdBt El AGENT 0 the herebyI cerlify Malt of to details and Information I have submitted or entered regarng this t are true and acciea to to the best of knowledge plumbing work and performed Wunder the pam issued for Mk;application w4 be In corn ; Massachusetts State Planting Code and Maoist 142 of the General Laws. P e8 of the PLUMBER-GA.FMER NAME 1.-e-5+"€-r t&kr.d e LICENSE# q$gyp c] r.tT RE MP❑ MGF® JP❑ JGF❑ LPG!❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME eV a Ce et TrncC.0.0,00-1 Peu.�r ADDRESS 43 Boni: ,r h Roe, CITY IlVastn.p.e STATE AM ZIP a.(.0 TEL 50 T-41-1 1--t Sr it FAX O t` CELL 50T-,I5 o—gs-v g ENTAIL 41‘. Cc%I-pi/5 P it- ° rS Gel W'1