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Home My WebLink AboutBLDG-23-000649 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .,' CITY YARMOUTH MA DATE August 08,2022 PERMIT# BLDG-23-000649 tr`;3i JOBSITE ADDRESS 45 MOORING LN OWNER'S NAME DONAHUE KEVIN M G OWNER ADDRESS DONAHUE CAROL PORTER P 0 BOX 213 WEST BROOKFIELD MA 01585 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 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 1 • 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 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 0 OTHER OF INDEMNITY CI 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 LESTER WADE LICENSE# 4569 SIGNATURE MP❑ MGF El JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY COTUIT STATE MA ZIP 026352702 TEL FAX CELL EMAIL infoAccipgenerators.com • MASSACHUSETiS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY a 1�vv�0�L`I L1 MA DATE 7;_ PERMIT# 23 " 0(045 JOBSITE ADDRESS `I5 Mc o ri� c1. OWNERS NAME b o n a.._h t'- Lev f`h GOWNER ADDRESS s+CL above TEI. 5-bt-`ono 9 FAx TXPE OR pT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY 'NEW:® RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO gi APPLIANCES FLOORS—. 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 B LER BOOSTER • CONVERSION BURNER COOK STOVE Dfl ECTVENITHEATER DRYER FIREPLACE • FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MMAKEUP 1ARR UNIT POOL HEATER ROOM!SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current ty Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ® NO 0 I FYO U CHECKED YES,PLC MINCATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BE OW LIABIUTYINSURANCE POLICY ® OTHER TYPE RINEMNITY 0 B ❑ OWNER'S INSURANCE WAIVF.JJ I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massadrusetts General Laws,and that my she on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY OWNS ❑ AGENT ❑ I hereby certify S he that al of the details and information I have submitted or enteredg this won are true and a i the best of,Massachusetts uml work and Installations per1omied under the pemdt issued for this application will be In compliance aN =�;i;_. , . State Plumbing Code and Chapter 142 of the General Lava. of PLUMBERS NAME Les-b ..r Wade- LICENSE# 4 5fo ��n RE�11 � � E MP❑ MGF® JP❑ JGF❑ LPG{❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Cap e_Ce ti S cCo.p4u1 zer.,01. Peit4R.. - ADDRESS a.3 Bei,eett,tin �e. CITY Ititaskp *, STATE JAW zIP (C)3co 4-9 TEL FAx sOlA CELL 50T-150—gin g EMAIL a'n P ce:i e 5eivei-a- to rs. c c wti