Loading...
HomeMy WebLinkAboutBLDG-22-005307 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH MA DATE (March 23,2022 PERMIT# BLDG-22-005307 JOBSITE ADDRESS 17 DUNSTER PATH OWNER'S NAME LOUGHLIN KAREN B G OWNER ADDRESS HALDE NANCY A 7 DUNSTER PATH WEST YARMOUTH MA 02673 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL PST ❑ RESIDENTIAL ED CLEARLY NEW: 0 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 1 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 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 (Andrew Leighton I LICENSE# 116130 I SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG( ❑ CORPORATION❑#I I PARTNERSHIP ❑# ILLC ❑#I COMPANY NAME: IANDREW R LEIGHTON I ADDRESS. 120 Brewster Rd, CITY IW Yarmouth I STATE IMA I ZIP 1026735706 I TEL I FAX I I CELL I I EMAIL IhalloilcompanyCa,amail.com -t IVIASSA >HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORI kirj: Ca zt /�r U . R. 0-10 U 7' 1 ,� hIA DATE /� PERMtT# 2'2—5'307 JOBSrTE ADM SS 7 .?v®ct.5 7e�2- Y,i LAG .-OWNER'S NAME Lprs /.v OWNER ADDR SS TYPE OR TEL_Of:e8C�-28tb FAX PRINT OCCUPANCY 1 'PE COMMERCIAL EDUCATIONAL REStDtTlTIAL 01 NEW: F lOVA11ON: RHsLACEMENT: PLANS SUBMITTED: YES NO i APPLIANCES Z FLOORS—. BOILER asp 1 illEMBIIIENIKE s 7 8 9 To 11 iYi is BOOSTER �] ��� . CONVERSION BURNER S� DIRECT COOK STOVE _��� �__ � • DIR VENT HEATER - ... _ . ,- DRYER 11111.111 FIREPLACE FRYOLATOR ����� IIIIMINIMIMM.111111111711111111111111 NMI GRILLEGENERATOR �' —�� INFRARED HEATER �_� •I.ABORATC)RYCOCKS "n. MAKEUP AIR UNIT = ��- .._ POOL HEATER �� - - MUM � ROOM!SPACE HEATER —IIIIII _ . — ROOF TOP LIMEY UNIT HEATER 11. TEST �"_�� . �� UNVENTED ROOM HEATER ��� "� � — WATER HEATER - �_ OTHER NM iiii t IIIIIIIIIIIINIINIII i I have a current ilatiffftv insurana policy or Its substanlial INSURANCE COVERAGE equivalent*Joh meets the requirements of MGL.Ch.142 YES :t/Sao I IF YOU CHECKED YES,PLEASE IN'ICATETHE TYPE OP COVERAIN BY CHECKING THE APPROPRIATE IBC BELOW LIABILITY URANCE POLICY V OTHER TYPE INDEMNITY OWNER'S INSURANCEB©ND WAIVER: am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,an that my signature on this permit appUcaBan waives this SIGNATURE OF C IYNER OR AGENT CHECK ONE •: OWNER AGENT I hereby owe&that en of-the chisels 1 all Memnon I taws submitted or entered regartffne this l 't Stateand that ati plumbing k and instal Code:teens Chapter Pew mooring peons issued fortis oIare•.f -- c m.. o? t Cf r142ofthe �, ��!�►, , .. GaneretLsws. u,;_• Of the PLUMBER-GAS FITTER NAME At 1REW Lew—iron LICENSE* 1B130-M MP' SIGNATURE i�►' � MGF JP JGF tFGI CORPORATION f # 3734C PARTNERSHIP COMPANY NAME HALL OIL CON.ANY INC. t'I C # ADDRESS 435 RT 134 CM' SOUTH DENNIS STATE MA ZIP 02680 TEL 508,398-3831 FAX 508.384.3088 CELL EMAIL balloicompanytagmalcom • ri