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Home My WebLink AboutBLDG-23-005247 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 23,2023 PERMIT# BLDG-23-005247 �t JOBSITE ADDRESS 1141 HIGHBANK RD 6 /" 4C'E 'S NAME HIGHBANK PROPERTIES INC G OWNER ADDRESS C/O BLACK ALEX 141 HIGHBANK RD SOUTH YARMOUTH MA 02664 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 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 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 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 James Connolly LICENSE# 15135 SIGNATURE MP© MGF ❑JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME James M Connolly ADDRESS. 92 DEXTER RD, CITY MARION STATE MA ZIP 027381237 TEL FAX I I CELL EMAIL I ASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM CAS FITTING WORK �4. 6 CIT`( y °'�i4:1 I��ir', DATE � �j��3 keg, y6D�Z�/� JGBSITE ADDRESS 6, SA-'f4y fr/S ..f n _ r ,c:} OWNERS NAME � r�G•. y,�r " OWNER ADDRESS .r o 66`-/- .3 j L1 Zun�S✓704, TEL -7 2Li 36? YS-V TYPE OR _f A.Y, PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL M CLEARLY NEW: I RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS BSIMI 1 2 3 4 5 6 7 BOILER 9 10 I i 12 '13 14 BOOSTER I CONVERSION BURNER, COOK STOVE __r___- DIRECT VENT HEATER DRYER FIREPLACE ---1--- i FP,YC�LATOR I FURNACE I GENERATOR GRILLE —I INFRARED HEATER I LABORATORY COCKS �� MAKEUP AIR UNIT I i OVEN --I POOL HEATER l —� ROOM I SPACE HEATER __ ROOF TOP UNIT �—' TEST UNIT HEATER UNVENTED ROOM HEATER � (� WATER HEATER i 1 OTHER 2f2 1 EUILDIVG DEPARTMENT Br. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I`I NO ElI 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 • Massachusetts General Laws,and that my signature on this permit application waives this requirement. • .} CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT "l-• 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 comp' e with all erti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. LE j PLUMBER-GASFITTER NAME LICENSE# ) 673 S'--- SIGNA URE MP rl, MGF❑ JP❑ JGF❑ LPGI ❑ CORPORATION Ili 01( PARTNERSHIP❑# LLC❑0 COMPANY Lh/�a-G tilt' I � NAME 1/V1 L �1 ADDRESS'� � C`'1c� / 1/h�4G C. �, �"� CITY /, 21-AK 64-4 rr STATE h ZIP U/�►c-5. 3 %� TEL 7�' h I>� i -�� FAX CELL `71'1 7! EMAIL l v+I5 p/ n, d 17`+ 4t ' /c _'