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Home My WebLink AboutBLDP-223-002573 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �; ; CITY 'YARMOUTH I MA DATE (November 09,20ZI PERMIT# BLDP-23-002573 ; y" JOBSITE ADDRESS 1225 ROUTE 28 OWNER'S NAME TAMS PROPERTIES LLC G OWNER ADDRESS 225 ROUTE 28 WEST YARMOUTH MA 02673 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ 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 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 0 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 (Chris Poire I LICENSE# 133901 I SIGNATURE MP❑ MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑#I I PARTNERSHIP 0#1 (LLC ❑#I COMPANY NAME: I I ADDRESS. 137 Calvin Drive, I CITY (Dennis I STATE IMa I ZIP 102638 I TEL FAX CELL 7748366461 EMAIL mcplumber angmail.com _ s MASSACH IUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11—f ,, Its Xcern J n �� N CITY Ivlr, DATE /1'— 0 ^,�- -- ZS-? PE:RMIT# 13— JOBSITE ADDRESS RI- A OWNER'S NAME aC S''e{-c (l rf GOWNER ADDRESS TEL FA?; TYPE OR OCCUPANCY TYPE COMMERCIAL['----....--- EDUCATIONAL PRINT ❑ RESIDENTIAL❑ CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS—+ BEM 1 ? 3 4 5 6 7 8 9 10 .i.l 12 BOILER 13 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER, _ (_ FIREPLACE FRYOLATOR FURNACE , GENERATOR GRILLE INFRARED HEATER ____I _ __C LABORATORY COCKS EC MAKEUP AIR UNIT ! �'� d OVEN POOL HEATER ROOM I SPACE HEATER -� 0 Z02 ROOF TOP UNIT s_ TEST . . . - B JILJING DEN . . -- UNIT HEATER INVENTED ROOM HEATERI WATER HEATER 7.:( -- OTHER _ I INSURANCE I have a current liability insurance policy or its substantial equivalent w hicOhVmees the requirements of MGL.Ch.142 YES nNO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY 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 Massach a.et:ts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT Er— ' I hereby certify that all of the details and information I have submitted or entered regarding this application ar t and a rate to the be knowl `— and that all plumbing work and installations performed under the permit issued for this application will be in a ianc th all Pertin rov ion y of the Ll -- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE#t /SI ` ATURE MP ❑ MGF❑ JP []""JGF❑ LPGI ❑ CORPORATION❑## PARTNERSHIP❑#t LLC❑##: COMPANY NAME P.`i—t_ A C CITY 7 Yc-vt. in r� STATE ilia -ZIP U 2--C CI I TEL FAX CELL 7 7 EMAIL