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HomeMy WebLinkAboutBLDG-23-000239 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . ��� CITY YARMOUTH MA DATE July 14,2022 PERMIT# BLDG 23-000239 JOBSITE ADDRESS 12A&12B ROSEMARY LN OWNER'S NAME 'JOHNSON NANCY L TR G OWNER ADDRESS N L JOHNSON INVESTMENT TRUST PO BOX 342 HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 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 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❑ 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 William Appleby LICENSE# 32093 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: WILLIAM J APPLEBY ADDRESS. 5 STEPHEN HOPKINS RD, CITY HARWICH STATE MA ZIP 026451251 TEL FAX CELL EMAIL wiapplebv0hotmail.com RECEIVED s n MAilSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITI N,G WORK 4 2022 cni: G Ya.t'mo , MA. DATE 6 i�z. .z�. PERMrr# z3 6)23 � ITYJ�.rf 3UILD G DEPt DRES`a`/r�/1 eeOSc'1n 2a y I �.h P NAM C3� G��A—� ,rt2? �d sv (3-- ERADDRESS:/s 0,130 3�J 2/ rsJ'4ifiAt M,il3 .20W/-/0 Y9FAX: TYPE OR OCCUPANCY TYPE COMMERCIAL 0 dtputATUAL 0 RESIDEKTIALX PRINT CLEARLY NEW:0 RENOVATIONX REPLACEMENT:0 PLANS SUBMIT kit YES X NO❑ APPLIANCES-1 FLOOR-, Bent 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 t s GRLLE INFRARED DATER _ LABORATORY COCK . iUN�N MAKEUP AR IT 4 OVEN v - POOL NEATER _ ROOM t SPACE HEATER _ -4 ROOF TOP LWIT TEST Z UNIT HEATER Lti UNVENiED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liabtlitv krsrrance policy or its substantial egtivalent which meets the remdrements of MGL.Ch.142 YES 00 ❑ If you have ciecked Y, please intricate the type of coverage by chedting the approiwime box below. LIABILITY INSURANCE POLICY yi OTHER TYPE=may 0 BOIL 0 OWNER'S INSURANCE WAIVED I au aware that the licensee does not have the instwance coverage requhed by Chapter 142 ofthe Massachusetts General Laws,and that my she on tttis t alOcation this re:Owned- ,, G C HCK ONE OILY: OWNER AGENT 0 SMATt E OF 0� /� hereby certNy that all of the details aid information I have submitted(or entered)regardrg this mmlicabon are true and accurAe to the best of my Knowledge arvIthat all p las work old instanalons performed under the peewit issued fortis applcalan be In wilt all provin of the Massachusetts State. g Code and Chaster 142 of the Gets Laws. • i le- PLUMBER/GASHIIhitNAMEM//ikeV 0�n684 �yLICENSE# 3?U t� TURE q J�ea.�;hR II��ADt : 02 JO I? . i e&Gn r.+4. 67,-eVe_ COMPAN/Y�NfR_ME/:I,,�r�l /��rsim,�i�h` d' CITY: Zildi /L'G/- SATE inn" ZIP. 002.46 7 FAX TEL O Oa) yo /3//( !NAIL: a)ji&pp/ ,_( AOf 1 /, corp MASTER❑ JOURNEYMANW LP INSTALLER 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# E/7?41 L., 4DZZe s = -