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Home My WebLink AboutBLDG-22-004667 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ViCITY IYARMOUTH MA DATE IFebruary 23,2022 PERMIT# BLDG-22-004667 JOBSITE ADDRESS 127 EARLY RED BERRY LN OWNER'S NAME IINSLEY DANA L G OWNER ADDRESS 4071 GREGORY DR DOYLESTOWN PA 18902 TEL I I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT 0 NO❑ CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES • 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 1 • 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❑ 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 — 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 IWilliam Heath I LICENSE# 112021 I SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPG! CI CORPORATION 0#I I PARTNERSHIP 0#I ILLC 0#1 I COMPANY NAME: IWILLIAM 0 HEATH I ADDRESS. 145 Main Street, I CITY (Sandwich I STATE IMA I ZIP 102563 I TEL I I FAX I I CELL I I EMAIL 1 I 1R. ECE VED 1 FEB 23 2022 50.M j3UI. DL'ARTMASA HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ry. CITY: YffA.Y»OVT-1-, MA. DATE: PERMIT# 2'Z- 41.41 JOBSITE ADDRESS:�7 6R / 49 4CIrt/ OWNER'S NAME: D/mil 101S 1(7 G OWNER ADDRESS: 44)7/ S1"Son1 t)br"11 TEL:2`7-3 o7'l`'762-FAX: TpOCCUPANCY TYPE: 7 COMMERCIAL❑ EDUCATIONAL ElRESIDENTIAL is INT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:V PLANS SUBMITTED: YES 0 NO❑ APPLIANCES-1 FLOOR Bsmt 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 VI INFRARED HEATER ,_ _ Mr. . LABORATORY COCK MAKEUP AIR UNIT 'NIOVEN POOL HEATER ROOM/SPACE HEATER 4 ROOF TOP UNIT air TEST , UNIT HEATER t4J UNVENTED ROOM HEATER 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 yE5,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY Er 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT 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. PLUMBERIGASFITTER NAME: 6wcc`04 of Ablra / LICENSE#/''1/Zv-z j SIGNATURE COMPANY NAME: 4+M kilt dick 4.-..inn.., ADDRESS: Yr- .'"'>✓ 1T'4 ct 1 CITY: ��^'0 ' `. 4► STATE: rkof ZIP: dz S 6 ? FAX: TEL: 5-De776 /or) 5— CELL: 77'/ Y'7 5/70 EMAIL: 'f•// •io447390 �J ,..�,/' e,:'', MASTER 24URNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# Ef?191L 09/Zite'SS : .