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HomeMy WebLinkAboutBLDG-22-007074 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ CITY YARMOUTH MA DATE June 07,2022 PERMIT# BLDG-22-007074 I;r JOBSITE ADDRESS 33 CRANBERRY LN OWNER'S NAME MUSE WILLIAM C G OWNER ADDRESS MUSE MARGARET A 33 CRANBERRY LANE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 DRYER FIREPLACE 1 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 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 (William Woods I LICENSE# 111887 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑#I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IWILLIAM T WOODS I ADDRESS. IPO BOX 702, CITY IW BARNSTABLE I STATE IMA I ZIP 1026680702 I TEL I FAX I I CELL I I EMAIL (adads10(d),comcast.net MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rg__-` (s 1 Kof . �,t_ MA DATE 04-01— PERMIT �'� � 6 CITY �. JOBSITE ADDRESS li Cie 1 / 61 . OWNER'S NAME A es/ OWNER ADDRESS r TEL "—___— FAY, TYPE OROCCUPANCY- PE COMMERCIAL EDUCATIONAL IONAL PRINK ❑ ❑ RESIDENTIAL�/ CLEARLY 77 NEW: RENOVATION: ❑ REPLACEMENT: El PLANS SUBMITTED: YES Id0❑ APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 g BOILER 9 1i) 1'I 12 I; I 14 BOOSTER —1 CONVERSION BURNER , COOK STOVE / • DIRECT VENT HEATER ` DRYER 1---- FIREPLACE / 1 FRYOLATOR FURNACE GENERATOR l GRILLE _ i INFRARED HEATER j LABORATORY COCKS • MAKEUP AIR UNIT I --I POOL HEATER R E C I x C ROOM I SPACE HEATER , ROOF TOP UNIT -___10 t A TEST UNIT HEATER _ - UNVENTED ROOM HEATER B�iLCiNC WATER HEATER - OTHER , I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ej 11O ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ j 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. • CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 `s- and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent pro ision of '` Massachusetts State Plumbing Code and Chapter 142 of e General Laws. Li j PLUMBER- ASFITTER NAME t /// 4°41-3 LICENSE#`/r7 SIGNATURE MP Pi MGF❑ JP ❑ JGF 0 LPG! 0 CORPO TION ) PARTNERSHIP 0 if LLC 0# COMPANY NAME G+Lf ADDRESS 16 iee.k7-0-____ CITY tt) ` )6 J STATE` ZIP ,); r TEL.4P 367 3(54E FAX 3�. -- 6 Z 3 CELL a)7 3837 EMAIL ffR (( i /° _ l CL 35q ° (90