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HomeMy WebLinkAboutBLDG-23-004395 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CL,It CITY YARMOUTH MA DATE February 08,2023 PERMIT# BLDG 23 004395 JOBSITE ADDRESS 9 ACADIA RD OWNER'S NAME Albert Denapoli G OWNER ADDRESS 9 ACADIA RD WEST YARMOUTH MA 02673 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 1 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 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 Andrew Hayes LICENSE# 16489 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PLUMBING SOLUTION BY HAYES ADDRESS. 22 Rustic Lane, CITY (Hyannis STATE MA ZIP 02601 TEL FAX CELL 7747225013 EMAIL PLUMB HAYES91 an,YAHOO.COM } SG 66 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Jj 1-�- P. p1/4 v MA DATE al t 12-3 PERMIT# Z-�'f i'l 9 FEB U U862- pJD ES. G At0..ido, �acA. OWNER'S NAME A-f rJ 0¢-�-c poL• ;. OWNER ADDS' q Occa;Ac 124ta TEL FAX'UILDINQ DEPARTMENT PIE PRINT COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: SUBMITTED: YES RENOVATION: ❑ REPLACEMENT:0 PLANS : ❑ NO[J� 1 APPLIANCES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 ----__ BOILER r BOOSTER CONVERSION BURNER .______J COOK STOVE -I DIRECT VENT HEATER DRYER — FIREPLACE I FRYOLATOR I FURNACE GENERATOR GRILLE INFRARED HEATER —1 LABORATORY COCKS MAKEUP AIR UNIT OVEN l POOL HEATER L_ ROOM I SPACE HEATER ROOF TOP UNIT TEST , UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 'NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er OTHER TYPE INDEMNITY ❑ BOND 0 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 CHECK ONE ONLY: OWNER ID AGENT El I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accura 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 wi Pertinent provision of the ku, Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Avldf.w l LICENSE# 14(WI SIGNATURE MP 2 MGF❑ JP 0 JGF❑ LPG'❑ CORPORATION 0# PARTNERSHIP❑# LLC 0# COMPANY NAME_RUN!)ti(1/ t)kJ,1doic �y f ADDRESS Oe`t a4.6-4-it. L i - CITY i)J Gym, S �l STATE 411 4 ZIP 02 is 6 TEL FAX CELL 11t1- 122- rd 1? EMAIL p tows