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HomeMy WebLinkAboutBLDG-22-002814 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 16,2021 PERMIT# BLDG-22-002814 °t JOBSITE ADDRESS 4 GULLS COVE RD OWNER'S NAME LOWENTHAL DANIEL A G OWNER ADDRESS LOWENTHAL NAOMI M ONE SOUNDVIEW DR LARCHMONT NY 10538 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL El CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 ❑ OTHER OF INDEMNITY 0 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 (Adam Hufnagel LICENSE# 15256 MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑#�� SIGNATURE ARTNERSHIP 0# COMPANY NAME: ADAM HUFNAGEL PLUMBING&HEATING ADDRESS. 167 Carriage LN ��LLC ❑#� CITY Barnstable STATE MA ZIP 02630 TEL FAX CELL 5083177409 EMAIL thehuff483(a,comcast.net / ASSSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w::; MA DATE ( I �- I PERMIT# 2"7•- Z 8I S JOSSITE ADDRESS ti G V \ \ S �ote OWNER'S NAME L 4"-L-c1 �_ 1 OWNER ADDRESS TEL 9 1 I r Ll1 t jA 3 TYPE OR PRINT OCCUPANCY-YFE COMMERCIAL❑ EDUCA i 101'J.4L ❑ RESIDENTIAL CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO❑ APPLIANCES 1 FLOORS--F esM 1 ? ; 4 5 s , e 9 10 '1'1 12 I BOILER 13 j BOOSTER --I CONVERSION BURNER COOK STOVE M DIRECT VENT HEATER DRYER, FIREPLACE j FP,YOLATOR FURNACE -----d— GENERATOR GRILLE _________I INFRARED HEATER _______ LABORATORY COCKS __________I MAKEUP AIR UNIT OVEN s `.`m" --- -- POOL HEATER • ROOM/SPACE HEATERI _���_, ROOF TOP UNIT • ' V t f 21_ ' TEST _ UNIT HEATER UNVENTED ROOM HEATER F,,• ' ` ,v r WATER HEATER OTHER I INSURANCE COVERAGE I have a current lial____atLinsurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES fl:ErNO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAG• 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. l - CHECK ONE ONLY: OWNER SIGNATURE OF OWNER OR AGENT ❑ AGENT ❑ ':`I-• I hereby certify that all of the details and information I have submitted or entered regarding this application are true a /accurate to the bes - • l `` and that all plumbing work and installations performed under the permit issued for this application will be in com li. `` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Y .nowledge `� P e with all Pe '-en o Sion of tl�e PLUMBER-GASFITTER NAME a Acm l-ki C-ac(i-e- / LICENSE MP ! MGF❑ JP JGF❑ LPG! ❑ CORPORATION /� L S SIGNATURE ❑# PARTNERSHIP❑# LLC 3 . Zc COMPANY NAME G[/1✓1 l)Alto( �� ' e tl (� �,� ADDRESS l 677 Cc c C '`1.) P L L 4'1 CITY a:-Wk S 6 l� STATE__Y6 ZIP 2(0 3 0 FAX CELL 562V -3(7 •--7 z 477 TEL EMAIL he J L(CP3 ? ti ,S LA