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HomeMy WebLinkAboutBLDG-22-006803 ,� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE IMay 24,2022 I PERMIT# BLDG-22-006803 JOBSITE ADDRESS 7&9 CHAMBERLAIN CT OWNER'S NAME DUNTON ELIZABETH G G OWNER ADDRESS DUNTON BRIAN J 7 CHAMBERLAIN CT WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 I 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 0 IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El 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 William Heath LICENSE# 12021 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME: WILLIAM 0 HEATH ADDRESS. 265 GREAT WESTERN RD,45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat3304gmail.com S310N M3I/13b NVld #11W2i3d $:333 ❑ ❑ IIV J2d 3H1 SV S3A13S NOI1VOIlddv SIHI oN saA S31ON NO1103dSNl 1VN13 /LINO 3Sf O103dSNI NO3 3OVd SIHl S310N NO1103dSNI SW)HJnOZI MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • fi— CITY: clv MA. DATE:' 11A- 7‘'7‘'?z PERMIT# JOBSITE ADDRESS: j C hA m /Aim/ ('T OWNER'S NAME: /9L T'S a j/ GOWNER ADDRESS: 3 •3,9'.Z t '�.�V) /46. 4'Si' , TEL: 7f• .794', 3.2L FAX: 110- j L TYPE OR - TYPE OCCUPANCY TYPE COMMERCIAL El ❑ RESIDENTIAL Er PRICLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Er PLANS SUBMITTED: YES El NO❑ APPLIANCEST FLOOR Bsmt 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 VI INFRARED HEATER 'w LABORATORY COCK _ MAKEUP AIR UNIT R G hV E OVEN 4 POOL HEATER 'MAY 20 '(t?D ' ROOM/SPACE HEATER NI ROOF TOP UNIT -- -` — 13 GU uILDIrvrf,�c AIBINT TEST Z UNIT HEATER I.� UNVENTED ROOM HEATER WATER HEATER - - INSURANCE COVERAGE - I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E ENO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [" OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:l 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 ❑ 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 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. (L_ PLUMBERJGASFITTERNAME: 41)%"41-,e /Lt�7 • LICENSE# M /2-' ./ SIGNATURE COMPANY NAME: '1(/-1 1"1 v:.c C -'( "..-I ADDRESS: )'S- T CITY: -�iY�n vv,c L, STATE: 'h''^ ZIP: &''=' G 3 FAX: TEL:SD),,' 76 it) CELL: 77 V Yf•7 ,5/ 7c' EMAIL: 3,//j £ i 7 3c C% -h67•e MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# [IC❑Ir E h7ivL. i9 DD12eSS : (QG