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Home My WebLink AboutBLDG-23-002710 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK BLDG-23-002710 CITY YARMOUTH MA DATE November 15,202; PERMIT# tc JOBSITE ADDRESS 777 WEST YARMOUTH RD OWNERS NAME Elite Connections G OWNER ADDRESS 777 WEST YARMOUTH RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 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 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❑ 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# 119681 I SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: 'MICHAEL R MCBRIDE ADDRESS. 9 Rustic Drive, CITY 'West Yarmouth I STATE MA ZIP 102673 TEL I FAX I CELL I EMAIL Istinger.mcbride(7a,gmail.com s �_-.-_� MAS ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k: 6 CITY �r1 t 2� � ,s0.5 Ad d f' MA DATE PEFtIv1iT ; '23 �`7/D JOBSITE ADDRESS • i NAME G Ol IVER'S NA, .� OWNER ADDRESS � I �I/1M c�7ge'S. TYPE OFF � A / 0 - , d�� _ GCCUP.gIJCy TYPE O� FhY, PRINT �'COMAI�RCIAL CLEARLY ❑ EDUCA�i IGPJAL ❑ RESIDEIJTIAL[�. NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ �5 `Z) PLANS SUBMITTED: YES 0 NO BOILERAPPLIANCES FLOORS-4 111111111111111111111111.11117111111"1111111111311 BOOSTER .131CONVERSION BURNER __ COOK S" 1111111111111111111111111111111 STOVE ill v MIN v v DIRECT VENT HEATER ---DRYERDRYER -allE11111110111 -_- FIREPLACE v FP ,1'CiLATORv v an lifill v _vvvv GENERATOR ,....ri v — v��__� INFRARED HEATER IIIIi .�LABORATORY COCKS v ' i,* n lMAKEUP AIR UNIT v IIIIII _ ��___ �� _v1�ivo�!vvZ7��INN POLL HEA,TEP v v lINIM—Wiljull � I ROOF TOP UNI T v _,■ ILDIN _ v vim D NMI UNIT HEATER ®_® ® vEL�R INVENTED ROOM HEATER UNVEN ED HEATER v _Nv _ OTHER v vIIIIII Mil MIN 11111111 .......________Emminimmimmoll_l_1111111111111111111Erjr. M INSURANCE COVERAGE I have a current li Malina6fli insurance olic fRAGE policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES A NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 0 LIABILITY INSURANCE POLICY [g OWNER'S INSURANCE WAIVER: OTHER TYPE INDEMNITY 0 BOND ❑ 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 `:t;: I hereby certify that all of the details and information I have submitted or entered regarding this application are true ❑ AGENT 0 and that all plumbingwork p and installations performed under the permit issued for this application will be in compliance with all Pertinent provision o' Massachusetts State PlumbingCode and Chapter•142 of the and accurate to the best of my ofth edge p general Laws. r PLUMEER-GASFITTER NAME I� �/ of the LICENSE# �' MP❑ MGF ElJP L1 JGF❑ LPGI SIGNATURE ❑ CORPORATION❑# COMPANY NAME PARTNERSHIP 0# LLC El# CITY ADDRESS f STATE ZIP FAX CELL TEL7 _ EMAIL .. 0 ,LA .