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Home My WebLink AboutBLDG-23-000002 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK YIt— CITY YARMOUTH MA DATE July 01,2022 PERMIT# BLDG-23-000002 JOBSITE ADDRESS 5 QUAIL RD OWNER'S NAME Tom Finelli G OWNER ADDRESS 02476 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ 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 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 " OTHER DESCRIPTION:outdoor firepit 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 Irobert wesley I LICENSE# 120481 I MP 0 MGF 0 JP El JGF 0 LPG' 0 CORPORATION 0#I I PARTNERSHIP ❑# SIGNATURE I I ❑#I I COMPANY NAME: IB&M PLUMBING AND HEATING I ADDRESS. 19 bear hill rd, I CITY Istoneham I STATE IMA I ZIP 102180 I TEL 17812792520 I FAX 17812792520 'CELL 17818449626 I EMAIL Ibobwesley0,verizon.net I F ,) = MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK gA its ,; If3I , L jt 6 CET(l , , .rr"b fiL...� MA DATE PERMIT f. 23 -- ooe 2— JOBSITE,�DCIR.ESS OWNER'S G NAME tE , 4vr°7 ,GWNER ADDRESS (1. a TEL � FAX OR TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑P RINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES _I FLOORS—+ 95M 1 BOILER 5 s 9 10 MIN 13 14 BOOSTER nall CONVERSION BURNER ______I COOK STOVEall DIRECT VENT HEATER DRYER _= FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE � J INFRARED HEATER LABORATORY COCKS ---- MAKEUP AIR UNIT OVEN IIIIIIIIIII POOL _ HEATER ' M. ii. ROOM/SPACE HEATER _ ROOF TOP UNIT all TEST UNIT HEATER �� INVENTED ROOM HEATER ri WATER HEATER OTHER CC INSURANCE I have a current IiabiBi insurance policy or its substantial er@ui�raler,ty �VmsC I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGEthe requirements of MGL.Ch.1 42 YES ❑ NO ❑ 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 Massarhusei:ts General Laws,and that my signature on this permit application waives this requirement. i '� SIGNATURE OF OWNER OR AGENT CHECKONE ONLY: OWNER ❑ AGENT ❑ `-1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and � and that all plumbing work p�:. 9and installations performed Linder the permit issued for this application will be in compile a curate t the of Massachusetts State Plumbing Code and Chapter 142 of the �' bestmy knowledge � p �enerai Laws. p i�1�rtinent pro\,ision of the PLUMBER-GASFITTER .!%�. LICENSE SIGNATURE MP ❑ MGF- JP ❑ JGF❑ LPG' ❑ CORPORATION❑It COMPANY NAME PARTNERSHIP❑�� LLC ADDRESS ".7 - CITY ,,� (,r STATE 1 ZIP C,l - TEL FAX ! / '` --•--�—/- CELL —1 7 -.), EMAIL ✓