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Home My WebLink AboutBLDG-23-000243 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w E` CITY IYARMOUTH MA DATE July 14,2022 PERMIT# BLDG-23-000243 JOBSITE ADDRESS I12A&12B ROSEMARY LN OWNER'S NAME 'JOHNSON NANCY L TR G OWNER ADDRESS IN L JOHNSON INVESTMENT TRUST PO BOX 342 HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ID PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 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 ❑ 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 (William Appleby I LICENSE# 132093 PARTNERSHIP SHIP ❑#I SIGNATURE 0#I MP❑ MGF 0 JP© JGF❑ LPGI El CORPORATION 0#I ( COMPANY NAME: IWILLIAM J APPLEBY I ADDRESS. 15 STEPHEN HOPKINS RD, CITY IHARWICH I STATE MA ZIP 1026451251 I TEL I FAX I I CELL 1 I EMAIL Iwiapplebv(ihotmail.com 1.�_ : i V' d a - •CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ _�.� ✓ter _% V 4 2A`uu: '� inoa*A MA DATE V%a/o2.�2.. PERMITr##-L3- 02.v JOBSl AD II- ss: /.V3 `t'oc'ein a. I. �, OWNER'S NAME /tea cif V d ;-4c3—0>y [13UiLDIGEPAr yp$iiADIRESS /9O,Rey07i/ y ,ls// Lfr) JO-1OV�AX: ay To3 (;Off/ 1YYEr UK OCCUR• TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:JE( REPLACEMENT:0 PLANS SUBMITTED: YEW'NO❑ APPLIANCES7. FLOOR-. Bunt 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 GRLLE , VI INFRARED HEATER t1tu LABORATORY COCK , MAKEUP AIR UNIT . cl OVEN — ," POOL HEATER ROOM f SPACE HEATER -.I ROOF TOP U NIT TEST Z UNIT HEATER 41 UNVENTED ROOMHEATER _ WATER HEATER / 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 have checked Yam,please indicate the type of coverage by checking the appropriate box below. UABIUfY INSURANCE POLICY W OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requked by Chapter 142 of the Massadxisdts General Laws,and that my signature on this permit application rim this requirement .: 7 CHECK ONE ONLY: OWNER%AGENT 0 SIGNATURE OF ER OR AG T /7 hereby certify that all of the details and information I have submitted(or entered)regarding this appicalion 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• .i= .,with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the Gem'Laws. �/�/'.f, /� '=- 930wPg PLUMBERIGASFITTF-R NAME 6.) //i ern .1 u eh', ,i CENSE# 3 *4 9�.G r r '/ RE T 1, p �r, COMPANY NAME:/J.I P/u m6i n7 �N ./1 .y�'RESS: arS 0 P,., elaoO4 al- 0^Cd! e— CITY:. J<j/9/ STATE: /724- 21P: 0.264 7 FAX: TEL: cELt670!)Slog`'.?//4 EMAIL:Wv4pp le-AA? Ca /ioY/72 7 i/, eat MASTER❑ JOURNEYMAN ILP INSTALLER 0 CORPORATION❑# PARTNERSHIP 0# LLc❑# c in,,i& RDDieess: .