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HomeMy WebLinkAboutBLDG-23-003863 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK j 'tla CITY YARMOUTH MA DATE January 17,2023 PERMIT# BLDG-23-003863 JOBSITE ADDRESS 8 SKYLINE DR OWNER'S NAME Jania De Silva G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ 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 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/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 Joseph Halloran LICENSE# 10984 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IJOSEPH M HALLORAN ADDRESS. 29 Forest Glen Rd, CITY Hyannis STATE MA ZIP 026012537 TEL I FAX I I CELL I I EMAIL sowdawgna.comcast.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK *k' CITY: YMA. DATE: / / L/ Z 3 PERMIT# JOBSITE ADDRESS: `- y L-r Ain. 0 ER'S NAME T,.�1�J OF Sri IG."I G OWNER ADDRESS: y!: 7"2� FAX: ty L4i S ti.�wit� TEL: /' _ r`S f� TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Er PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑' PLANS SUBMITTED: YES❑ NO❑ APPLIANCES1 FLOOR-4 Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I _ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR _ FURNACE GENERATOR GRILLE VI INFRARED HEATER Li LABORATORY COCK _ MAKEUP AIR UNIT ' OVEN POOL HEATER ROOM/SPACE HEATER J ROOF TOP UNIT ' TEST L Z UNIT HEATER t4.1 UNVENTED ROOM HEATER WATER HEATER J Cos .�,.4 7— / , . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES M/NO ❑ if you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY a- 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 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the bf my Knowledge and that all plumbing work and installations performed under the permit issued for this application will In ance nent provision of the Massachusetts State Plumbing Code an Ch ter 142 )f the General Laws. / PLUMBER/GASFITTER NAME: T�'S(r ti 4 /C(L4Ad LICENSE#/U �'�� SIGMA RE COMPANY NAME: J c J e;MA, l c "?�r C r ti .0/1 /?� �r'J' 1 7` ADDRESS: Z� rt1 R l 1 �I ` y CITY: f T j'titi1 s STATE: /t//4 ZIP: V £ c'f FAX: TEL: CELL: Sac&- C -Zn 3,7 EMAIL: 5 C t.,/c:1,t�}LJ ` e..) C' MC4 s j. ,ti' MASTER a'JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑ c h7 f}/C, ADitZe-Ss . _ i i