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HomeMy WebLinkAboutBLDG-21-004855 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11 c/ CITY YARMOUTH MA DATE February 26,2021 PERMIT# BLDG-21-004855 iJ n Fq 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 III PRINT CLEARLY NEW: ❑ 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 1 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 IPeter Hassett LICENSE# 11682 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: 'PETER J HASSETT ADDRESS. 8 Skipper Lane,Hassett Plumbing&Heating Inc. CITY 'Yarmouth Port STATE MA ZIP 02675 TEL FAX I CELL EMAIL 'peterjhassettAgmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r y CITY 'Yarmouth MA DATE 12/26/2021 PERMIT# Q L D G -z 1-bO r-B S JOBSITE ADDRESS167 Balsam Way i OWNER'S NAME iRcchard M.Quirk,Jr OWNER ADDRESS !Richard M.Quirk?Jr. TEL N=_s.v__ .___ FAX ._ P,.w ... .. . TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT EDUCATIONAL ° RESIDENTIAL in CLEARLY NEW _ RENOVATION: 3 REPLACEMENT: PLANS SUBMITTED: YES v NO r APPLIANCES 1 FLOORS-0 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 FRYOLATOR1111.101 11111111M1111111111111111110011.11.4111111111.111111111111111 , ina FURNACE GENERATOR sminatorimassionsittaasslatamtinuriamaistai GRILLE IIIIIIIIIMIIEIIIINFIIIIIIIIIIIRIIIIIIVINIEIIIIIIIIIIIIIMIIIFIIIIIFIIIIIIIIIIIIIIIIIIIIIIIINI INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER sminarininuenvinuissianiviiiiminormaimeitnit ROOF TOP UNIT IIIMIIIIIIIIIIIOIIIIIIIIIIIIINIINIIIIMIIIIIOIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIJIIINIITEST UNIT HEATER sotaitintniruntanumrearsiormirealmilmoramireit UNVENTED ROOM HEATER 1111011111111111*-111111111IIMMOM111111.11110.11,1111111.1101 WATER HEATERrionnemenuarstosaitamom OTHER Move gas meter ! INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES . NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ,x OTHER TYPE 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. CHECK ONE ONLY: OWNER I AGENT NR 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 com i ce ' al - t provis'•n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 44-- u a� PLUMBER-GASFITTER NAME,Peter J.Hassett LICENSE# 11682 SIGN' URE MPG.. MGF y JP , JGF£x t LPGI CORPORATION i'# 3506 PARTNERSHIP „# i LLC # COMPANY NAME A Hassett Plumbin and HeatingInc ADDRESS=8 Skipper Lane CITY Yarmouth Port ' STATE° MA ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 i EMAIL peterlhassett marl come u