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HomeMy WebLinkAboutBLDG-21-006838 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7L, CITY YARMOUTH MA DATE May 24,2021 PERMIT# BLDG-21-006838 1i 6- `' RE S 24 AMOS RD OWNER'S NAME CARDUCCI DEBORAH J JOBSITE ADD S G OWNER ADDRESS 8 LELAND RD NATICK MA 01760 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 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 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 Christopher Murphy LICENSE# 16548 SIGNATURE MP© MGF ❑ JP❑ JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: Blue Bear Plumbing ADDRESS. 100 Corp Park Dr,Ste 1740, CITY Pembroke STATE MA ZIP 02359 TEL 7817064682 FAX CELL 7817832414 EMAIL 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