Loading...
BLDG-23-002466 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK � CITY YARMOUTH MA DATE November 04,202'4 PERMIT# BLDG-23-002466 JOBSITE ADDRESS 104 PLEASANT ST OWNER'S NAME GREENE MARJORIE J TR(EST OF) G OWNER ADDRESS GREENE PLEASANT ST RLTY TRUST 40 CROSBY ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 1 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 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 Mark Watson LICENSE# 3842 SIGNATURE MP 0 MGF © JP 0 JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: IMARK D WATSON ADDRESS. 181 CAPTAIN PERRY RD, CITY IBREWSTER STATE MA ZIP 026312559 TEL I FAX 1 I CELL EMAIL Ipieman83ta7.comcast.net P>AA�>sACFIU ETT UNIFORM APPLICATION FOR A PERMIT TO PEf FClf�f`,11 CAS FITTING I+ ORK fl0A. 2A. RE.ss YC( R � 0 ��" \ MA DATE PEI tIv11T Z - 764 l (`7 (� (�[ OWNER'S NP,ME ��TC ST N OWIJ AD PESe TEL BUILDING DE•'ARTMENT FAX PRINT '-_. . • TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL{�CLEARLY X NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS—+ SSM 1 3 4 5 6 7 BOILER 9 I'I 12 13 14 BOOSTER CONVERSIONKSTOVE BURNERCOOK STOVEVE DIRECT VENT HEATER ■ ■ DRYER FIREPLL ■ ■■��■ FIRACE FP,1'C?LATOR FURNACE _GENERATOR r h \S e GRAEINFRRARED RC :111 LABLABORATORYy COCKS O COCf;S MAKEUP AIR UNIT �---- OVEN POOL HEATER ROOM!SPACE HEATER ROOF TOP UNIT TEST - UNIT HEATER UNVENTED ROOM HEATER 1 1 WATER HEATER OTHER I have a current liabilityINSURANCE COVERAGE insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ain I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE Y CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY ❑ 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 CHECK ONE ONLY: OWNER AGENT El '.l-, I hereby certify that all of the details and information I have submitted or entered regarding this application are true a d a curate th `-1 and that all plumbing work and installations performed under the permit issued for this application will be in co f my hn ledge - Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ith all erti i � `J PLUMBER-GASFITT-R NAME / LICENSE it- 3B7/Z SIGNATURE MP ❑ MGF JP ❑ JGF ElLPGI ❑ CORPORATION ❑# ❑is PARTNERSHIP❑it LLC COMPANY NAME Nl 1AR IS ,, '-1"0 S R V ADDRESS C b e r 2 0 �e w er y CITY ^� STATE U vl A ZIP 02 6 I FAY: CELL l 7Y 21 C71 W ( EMAIL IP( e MCI (/�TEL 5 (, - Id ,7