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HomeMy WebLinkAboutBLDG-21-005949 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -1,,; - CITY YARMOUTH MA DATE April 14,2021 PERMIT# BLDG-21-005949 JOBSITE ADDRESS 67 BALSAM WAY OWNER'S NAME QUIRK RICHARD M JR G OWNER ADDRESS QUIRK NANCI L 67 BALSAM WAY YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 1 DIRECT VENT HEATER DRYER . FIREPLACE • FRYOLATOR . FURNACE • GENERATOR GRILLE 1 . 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 ❑ 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 (Peter Hassett LICENSE# 11682 I SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: (PETER J HASSETT ADDRESS. 18 Skipper Lane,Hassett Plumbing&Heating Inc. CITY 'Yarmouth Port STATE MA ZIP 102675 TEL I FAX 1 I CELL EMAIL Ipeterjhassett(a)gmail.com I t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �_ a tl i_ ' CITY !Yarmouth - 1 MA DATE 14/12/2021 1 PERMIT# 131_ IA-a,CI t15 JOBSITE ADDRESS 67 Balsam Way F-ch _ W> �OWNER'S NAME IRichard Quirk et al 1 GOWNER ADDRESS Richard Quirk et al 1 TELL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 1,j EDUCATIONAL 13 RESIDENTIAL 0 PRINT CLEARLY NEW:11 RENOVATION:0 REPLACEMENT:J PLANS SUBMITTED: YES 0 NO. APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - - COOK STOVEm Mallet DIRECT VENT HEATER M' ' DRYER MNI_,M!, 111,11.11111MM MINN __ MN" _ &I FIREPLACE FRYOLATORNo t FURNACE ...inirWikm , , t smog...an , __ _ ._ _ ___ , GENERATOR GRILLE MI- -- NMM III MOM INFRARED HEATER MO WO.*WM M. LABORATORY COCKS MAKEUP AIR UNIT nw.rt OVEN C POOL HEATER - - ROOM/SPACE HEATER < ROOF TOP UNIT t , TEST NM ON NW MI NW 11.111111111.1 WI NM MN all 11111F-1111111111111 UNIT HEATER r ,Wa UNVENTED ROOM HEATER WATER HEATER OTHER -ter.. :_.: _ �::v.,. >_ ..:�. nn - p - tea. .- _iraweaa'� mieliiiiiiiiimic 1«. __ 5 .— . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0. OTHER TYPE INDEMNITY 0 BOND Li 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 Ej AGENT 6 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 a • .., urate to the •- t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp•- with - j, • ; '•• •f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �� .Ed PLUMBER-GASFITTER NAME Peter J.Hassett i t ` �/ , LICENSE#= 11682 SIG A URE MP EA MGF 1 ._1 JP LA JGF 0 LPG!fl CORPORATION 9#13506 PARTNERSHIP , #i 1 LLC, # COMPANY NAME.'Hassett Plumbin and Heatin Inc. ADDRESS 8 Skipper Lane CITY €Yarmouth Port �� _. STATE LMA1 ZIP 102675 TEL i 508-744-7555 FAX I CELL'508-237 2175 EMAIL 1 peterlhassett a�gmail.com 1