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HomeMy WebLinkAboutBLDG-23-000807 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE 'August 16,2022 I PERMIT# BLDG-23-000807 JOBSITE ADDRESS 111 SISTERS CIR OWNER'S NAME IRANA MAHMOOD M G OWNER ADDRESS 111 SISTERS CIR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: m 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 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 David Houde LICENSE# 4333 SIGNATURE MP❑MGF❑JP❑ JGF❑ LPG' 0 CORPORATION©#4333 PARTNERSHIP ❑# LLC❑# COMPANY NAME: McDonnell Mechanical Services ADDRESS. 79 School Street, CITY West Dennis STATE MA ZIP 02670 TEL FAX CELL EMAIL S3 LON M3IA321 NVld #iJIN2j3d $ :33d ❑ ❑ 11Wb3d 3H1 SY SRAd3S NOI1VOIlda SI1-11 oN saA S2ION NOI103dSNI 1VNld A1N0 3Sl 210103dSNI 2lOd 3DVd SIHl S310N N01103dSNI SVD Fiona'