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Home My WebLink AboutBLDG-22-005684 • 'R ,411, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE April 05,2022 PERMIT# BLDG-22-005684 JOBSITE ADDRESS 60 BROADWAY UNIT 12 OWNER'S NAME (THE TIME SHARE ESTATE TRUST G OWNER ADDRESS 1 ARDELL RD BRONXVILLE NY 10708 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 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 GENERATOR GRILLE • INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER • ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 0 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 (Donald Raymond LICENSE# 125836 SIGNATURE MP❑ MGF 0 JP© JGF❑ LPG( ❑ CORPORATION 0#I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IDONALD L RAYMOND ADDRESS. IPO BOX 522, CITY IYARMOUTH PORT STATE MA ZIP 1026750522 TEL I I FAX 1 CELL 1 EMAIL IexpertenerQvhvac(a).Qmail.com 1 i =_ _ LR l APPLICATION FOR A PCRMF TO PERFORM t FITTING WORK s ..! .r WY; (-[ As c . DATE (5( - FBNIFT# -2-1- s f.g V D�� t-' maws we . Fu r-S T OR OCCUPANCY Typl .❑ EDUCATIONAL 0 mot. i PRINT ' a CLEARLY KW:ElRENOVATIOPt 0 R ET CIR MiSStflNT1 YES No E' APPLLANOE81 FLOOR- _Bent 1 2 3 4 5 6 7 8 9 10 11 12 13 14 G, BOOSTER . , cos COOK STOVE ,41: DIRECT VENT FEATER REPLACE I GENEiATDR . LINFRARED HEATER LABORATORY COCK v _ av KEUP AIR MT -, ` RECEIVE 6— POOL HEATER 44 itROOM/SPACE ATER ,— R0oFTt3Pt t APR 45 71 7 T UNIT NEATER Muir�ir�o r�crArTrMery r 44 UNVENTED FiEATB( . v.._,., . _ WATER HEATER I have•a current WNW ir1s ance policy or iftsubstandel etpdeMbiledich owes the requislionts of M6L.th 142 YES NO 0 Uyou have checked ,please baste*Hyped by sbeckingInapproprlalebox beiorc UADLIlY IInANCE POUCY id aTIRRTYPE mown' 0 BOND ❑ *NERS INANANCE WARM Ianr aunt Mettle iloeneb SiInseam=Nap mpdrad by Chapter Mz&the Massachusetts General Lama„widths the my stoma on Mb peraelt apRlcetion t.Nan ihb rapinuneet. SIGNATURE OF OWNER OR}4(f alecx.o o*.y: OMER❑ AGENT ❑ herY mei that oldie details and informable I hew submits'Wanking nvenline ids appioedon se hue 7 - WKne a hatalplumbing indine pal �denspertieuadtriteepploalanWI, , ' provision of the�Stak Renting�andC �dee General Lao. J I PLUMBER/CASFrI TER NAME 11- (Nwt0 ,A) B-� _ • r`, . COMPANY NA E of F -e._, ADDREst_AA). C-t Lir) A art: uAL) SPATE UVVk. IP: -e,Z FAX TEL: Ca ' B>-- i(4 wt: 1,4 ,: k N/ MASTER 0 JOURNEYMAN E LP WISTALLER 0 COI'ORATiON❑s PAIR O; LW 0# t m$/L AbZ cuss: C 5 rr....- 5''‘--`�t>� (i'X` WE c F C�'