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HomeMy WebLinkAboutBLDG-23-004445 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK wl 47 CITY YARMOUTH I t MA DATE February 12,2023 PERMIT# BLDG-23-004445 JOBSITE ADDRESS 317 PINE ST OWNER'S NAME MARIANNE FERRI G OWNER ADDRESS 1384 WASHINGTON ST NORWOOD MA 02062-4021 TYPE OR OCCUPANCY TYPE CO TEL PRINT MMERCIAL ❑ RESIDENTIAL El CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ FIXTURES FLOORS—. PLANS SUBMITTED: YES ❑ NO El BOILER BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1111 BOOSTER - CONVERSION STOVE Mil - COOK STOVE DIRECT VENT HEATER = DRYER - FIREPLACE FRYOLATOR = FURNACE Ell - GENERATOR - GRRAR NI GRILLE HEATER LABORATORY COCKS Ell INFRARED AIR UNIT = OVEN - POOL HEATER __ ROOM/SPACE HEATER ___ - ROOF TOP UNIT - Mill IIIIII wimmaugaimmmilimml UNVENTED ROOM HEATER __ _ - OTHERMiral 1 ___ _ NI - OTHER DESCRIPTION: 11.11111111.111111111111111111111.11111111111111.1111111111111111111111.111111111111.11111:1111 INSU NCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW YES El NO 0 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 42 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 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. the best of my PLUMBER-GASFITTER NAME MP 0 MGF CI JP El 0 LPGI CORPORATION❑# PARTNERSHIP LICENSE# SIGNATURE COMPANY NAME: CITY ADDRESS. 0# --ILLC ID#� FAX STATE �ZIP CELL EMAIL TEL ©!,t- 2- 1I�) 2.3 G