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HomeMy WebLinkAboutBLDG-22-004327 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0 ,— CITY YARMOUTH MA DATE February 03,2022 PERMIT# BLDG-22-004327 t=f� a JOBSITE ADDRESS 932&940 ROUTE 28 OWNER'S NAME BASS RIVER REALTY LLC G OWNER ADDRESS 113 PLEASANT ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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❑ 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 Sean Oleary LICENSE# 3957 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: SEAN F OLEARY ADDRESS. 2 FABYAN RD,2 FABYAN RD CITY Plymouth STATE MA ZIP 1023602390 I TEL FAX 1 'CELL 1 I EMAIL advantageheatacna,gmail.com '' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK PE ri CC( 1` _ V2m( o' CIT5 /� MA DATE 2O� PERMIT Z � �3 Z-1 JOBSITE ADDRESSADDRESS ( ?�I • g OWNERS NAM --5-' t' G OWNER ADDRESS Cal VA TEL u-6/12- ?l, FAX 1 �- TYPE OR P IN OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ � APPLIANCES 1 FLOORS-4 ssm 1 2 3 4 5 6 BOILER o 9 10 11 12 13______I BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - DRYER �-� FIREPLACE ----� FRYOLATOR --- FURNACE ✓ I GENERATOR GRILLE _ _____I INFRARED HEATER LABORATORY COCKS _ ____________I MAKEUP AIR UNIT • OVEN --j POOL HEATER __._J rRh ,ROOM/SPACE HEATER I � ROOF TOP UNIT �_� �a_ _' ` '�`-® TEST -. �� u UNIT HEATER UNVE€�ITED ROOM HEATER —� -.._ WATER HEATER • �UILU(Nv UtNART ENT OTHER I t INSURANCE COVERAGE I have a current lial_ghtLinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES • I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE-, hl0 ❑ .• .BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY V OTHER TYPE INDEMNITY ❑ BOND ❑ • DINNER'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► NE O Y: OWNER ❑ 9N1 ❑ -• I hereby certify that all of the details and information I have submitted or entered regarding this application are true accurate to the best o y knowledge ~``` and that all plumbing work and installations performed under the permit issued for this application will be in compli e with all Pertin �t pr I ion of he " Massachusetts State Plumbing Code and Chapter 142 of the P General Laws. PLUMBER-GASFITTER NAME LICENSE# 3n j7 SIGN ,E MP ❑ MGF❑ JP ❑ JGF LJ LPGI ❑ CORPORATION❑:# PARTNERSHIP 0 i COMPANY NAME �r LLC❑# ADDRESS •� • 111 L CITY �� ��(��� STATE Ail_- ZIP � ' 36 C> � ¢ Z / TEL j_ ! Cj > O0 FAX CELL '���_ ( ( EMAIL.