HomeMy WebLinkAboutBLDG-23-004262 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE February 01,2023 PERMIT# BLDG-23-004262
JOBSITE ADDRESS 15 BARNACLE RD OWNER'S NAME Nick Papakvrikos
G OWNER ADDRESS TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL
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
DIRECT VENT HEATER
DRYER
FIREPLACE .
FRYOLATOR
FURNACE 1
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 1
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 CI 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 'Kevin Meehan LICENSE# 111877 SIGNATURE
MP 0 MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME: IKEVIN M MEEHAN ADDRESS. IPO BOX 35833,
CITY IBRIGHTON STATE MA ZIP 021350014 TEL I
FAX I CELL I I EMAIL Ipimc007(a,hotmail.com
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4A•ASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
1 R kl.li7L-; E D
:_w MA DATE -3 I'23 PERMIT �� Ct 2
1 JAN 312O230B T: ADDRESS 1 S. Zo-rnac te_ ( .. OWNER'S NAME_IJ cic P c,k yr;kos
i �^ �D
B ILDINv EPARTP RDRESS TEL FAX
•
P T` U I. NCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL[
CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:[— PLANS SUBMITTED: YES❑ N0LY
APPLIANCES 7. FLOORS-► BOO 1 2 3 4 5 6 7 8 9 10 11 12 1; 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE -
DIRECT VENT HEATER _H.-1H
DRYER
FIREPLACE
FRYOLATOR
FURNACE i —J
GENERATOR -
GRILLE
INFRARED HEATER )
LABORATORY COCKS -
MAKEUP AIR UNIT
OVEN
POOL HEATER •
ROOM I SPACE HEATER
ROOF TOP UNIT L
TEST - .
UNIT HEATER
a UNVENTED ROOM HEATER •
WATER Ha. EATER I
OTHER
•
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E-wO ❑
d I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
J LIABILITY INSURANCE POLICY la- OTHER TYPE INDEMNITY ElBOND ❑
i• 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 ❑ AGENT El
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 corn liance with all Pertinent provision of the
`''LEIMassachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME - -
LICENSE# ►t g iR- SIGNATURE
MP❑ MGF Er JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑#
COMPANY NAME M 664i- t-N PLa r (•}T&• ADDRESS r 0. 3SE*3
CITY 13o561 n STATE VI4 ZIP 09--13 f' TEL .tW2e1.- es -a
FAX CELL S YR-,2 4/-c/S-40 EMAIL / J C. 00 7- lidb- 1(-c:o cy