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Home My WebLink AboutBLDG-21-006061 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE April 21,2021 PERMIT# BLDG 21-006061 JOBSITE ADDRESS 47 WOOD RD OWNER'S NAME james delaney G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 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 1 , DIRECT VENT HEATER 1 DRYER , FIREPLACE , FRYOLATOR . FURNACE . GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS . MAKEUP AIR UNIT , OVEN . _POOL HEATER , ROOM/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 Michael Mcbride LICENSE# 19681 SIGNATURE MP❑ MGF ❑ JP© JGF 0 LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: IMICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX I CELL EMAIL Istinger.mcbridet gmail.com ,1 4.6 II: .` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT P GAS FITTING WORK _,,-- C(TY: �� VGf l`,/l�l) A MA. DATE L PERMIT# G JOBSITE ADt 7 11tf x d j Q�,� s NAME:j g v o OP7 q,i / OWNER OREESSS_6 li/ ,Sr . 7 � , AX: TYPE OR o rim `j C LJ DUCATIONAL PRINT 0 itESOBtTUU.0 CLEARLY N RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO, P u ti c.2 s APPLIANCES1. FLOOR-4 Bent 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 GRLLE SA INFRARED HEATER w LABORATORY COCK c MAKEUP ARUNIT " A OVEN ,ZI POOL HEATER ROOM/SPACE HEATER I ROOF TOP UNIT "Z TEST .Z UNIT HEATER t,V UNVENTED ROOM HEATER WATER HEATER I have a ccarent liability insurance policy COVERAGE ply or its substantial equivalent which meets the requRenrents of MGL Ch.142 YES ief NO 0 If you have decked IE1,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the irrstemrce coverage requied 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 0 AGENT 0 hereby certify that all of the details and information I have sebmitted(orraged%this application are true and agate to the best of my Knowledge and that all plumbing work and installation performed under the perndt issued for this will be In provision of the �Pksnlbhg Code end Chapter 142 of the General Laws. R \j ___ / with a9 Pertinent PLUMBER/GASFITTER NAME:NI k t 14 c1 A L- J r n LICENSE*/ i �� , / !W! / SIGNATURE COMPANY NAME: i _` f 1 C r L� ADDRESS: /Z-v S,tic 40 t, "" t' D Z�7� FAX CITY: 1�J ,G( t�M a[J, STATE ZIP: TEL: • ILL '1- -1 . /vn c J.. r r p t I L• to—v. MASTER 0 JOURNEYMAN LP INSTALLER 0 CORPORATION❑#NO P PARTNERSHIP 0# LLC❑# c/VMet— 09/242ess.