The URL can be used to link to this page

Home My WebLink AboutBLDG-22-003336 #A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' s CITY YARMOUTH MA DATE December 13,202" PERMIT# BLDG-22-003336 JOBSITE ADDRESS 441A ROUTE 6A OWNER'S NAME KELLEY STERLING R G OWNER ADDRESS KELLEY JEAN 441A ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 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 El 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 Juan Candelario LICENSE# 1292 SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: Juan Candelario ADDRESS. 70 WINTHROP RD, CITY PLYMOUTH STATE MA ZIP 023601227 TEL FAX CELL EMAIL w ' L. IT�N!CaZUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1` i .1 i (� t- I) F Li i MA. DATE 1[.)f(11c)G PERMIT# JOBSITE ADC RESS: 9 l PI L.t�i U I _._ .. ,_ OWNER'S NAME: BU e G❑EdpV griiSB: C 1lt (111'1 (...� TEL FAX: By --�1ra OR OCCUPAN TYPE: COMM ER AL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 APPLIANCESZ FLOOR-, Bsmt 1 2 3 T 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER V CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER NZ FIREPLACE `7 FRYOLATOR FURNACE GENERATOR GRILLE kr) INFRARED HEATER u LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM!SPACE HEATER -4 ROOF TOP UNIT t TEST UNIT HEATER t‘ti UNVENTED ROOM HEATER WATER HEATER l INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Er1,10 ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 21 OTHER TYPE 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 CHECK ONE ONLY: OWNER 0 AGENT ❑ hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurat to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application In corn nee with all P enter provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. n PLUMBER/GASFITTE, AMEL L �l ��.�� lei r 1 6 LICENSE# (" SIGNATURE COMPANY NAME:./1' 'y714:4 ADDRESS: /- i'efr.-11% CITY: 4/14//C/J OYG - STATE /,/t't ZIP: �1' -/ ( FAX TEL: CELL: 1 I(.l` t 7 ' EMAIL: MASTER 0 JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# tic❑# E h9 eic. ADDizess: