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Home My WebLink AboutBLDG-22-000520 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK � �, t CITY YARMOUTH MA DATE July 28,2021 PERMIT# BLDG-22-000520 JOBSITE ADDRESS 303 PINE ST OWNER'S NAME MCNIFF WILLIAM T G OWNER ADDRESS MCNIFF MARY SULLIVAN 13 ORIOLE RD MEDFIELD MA 02052 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO El 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 1 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❑ 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 Paul Hamilton LICENSE# 10269 SIGNATURE MP 0 MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PAUL N HAMILTON ADDRESS. CITY STATE ZIP TEL FAX CELL EMAIL �-s;._,` MASSACHUSETTS UNIFORM APPLICATION FOR A PERM TO PERFORM GAS FITTING WORK kP WWI Y + h ft m e47 01`: ,IL, y, CITY h�iP, DATE n PERMIT*g{�ad- S2� JOB, E ADDRESS 3 fi,cfc) 5•7-- OWNER'S NAME 8/ lick t` ( GOWNER ADDRESS 3e2 PA) I TEL4.,/2 O ?/�`3 7/3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Ile..--- PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES O FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 •I5 1' BOILER BOOSTER CONVERSION BURNER, I COOK STOVE I • DIRECT VENT HEATER �. i DRYER, __, E. �. ® I FIREPLACE .__._ . FRYOLATOR FURNACE .. 2 g I GENERATOR i _ 4r____ GRILLE / BUI� • � L INFRARED HEATER ,- LABORATORY COCKS !! MAKEUP AIR UNIT I OVEN 1 POOL HEATER • ROOM I SPACE HEATER 1 ROOF TOP UNIT TEST . .. ... . .. __ UNIT HEATER (INVENTED ROOM HEATER WATER HEATER ' OTHER j INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ik11.1g [] I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND El • 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 ❑ 3 SIGNATURE OF OWNER OR AGENT :I-, 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 complianc with all Perti nt i ' not the `` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ii PLUMBER-GASFITTER NAME LICENSE#/La `NA R MP V/MGF❑ JP El JGF❑ LPGI ❑,, CORPORATION El It PARTNER-'HIP❑ ` LLC❑# COMPANY hIAMER'L Arbp v r'�.W i cf=3 � fiUGP.ESS 1] Y i5� CIT STATFNA____ ZIPer 7 TEL FAX CELL.t 0 j0 02.7 EMAIL OMMONW LTh m--•�.-- Dr .........:::. ::,IVISION OF PROFESSIONAL L CENSURE :" BOA.RD OF PLUMBERS ANF GASFITTERS' ., ISSUES THE FOLLOWING LICENSE MASTER PLUMBER :,:.:.:::::....„:.:,,,,„:„:„„,,„,... 1MLLIAM T HORAN .. �' 225PLgIN$T ,� •STOUGHTON MA € �' 02072 3187 1 W 10268 05/01/2022 882382 k' LICENSE NUMBER • EXPIRATION DATE • SERIAL NUMBER .. ,.\