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HomeMy WebLinkAboutBLDG-22-006806 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Y (d LCITY YARMOUTH MA DATE May 24,2022 PERMIT# BLDG 22 006806 4,> JOBSITE ADDRESS 7&9 CHAMBERLAIN CT I OWNER'S NAME Colleen Altison G OWNER ADDRESS 7 CHAMBERLAIN CT WEST YARMOUTH MA 02673 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 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/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 William Heath LICENSE# 12021 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: WILLIAM 0 HEATH ADDRESS. 265 GREAT WESTERN RD,45 Main Street CITY Sandwich STATE MA ZIP 026452428 TEL FAX CELL EMAIL billsboat330 a(�gmail.com S310N M3IA3N NVId #1IW213d $:33d ❑ ❑ 1111$3d 3H1 SV S3A213S NOIlVOIIddV SIHl oN saA S31ON N01133dSNI 1VNId AINO 3Sl 2I0133dSNI 210d 3OVd SIHI S310N N01103dSNI SVO HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 VCITY: `-/r44 trl cvT� MA. DATE: 7h'7 2 Lt,z z PERMIT# L tr S JOBSITE ADDRESS? Cl/4m6 eiL�49"'/ Cr OWNER'S NAME: 4L-7---/.S vn/ GOWNERADDRESS: 73 r34z -° 454'9 //Y4°44'56-.4 TEL: 9"2Y 79U 34'2Z FAX: i"7,1 4 iyYZ- TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL[Y PRINT CLEARLY NEW:12/ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ APPLIANCES FLOOR Bsmt 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 , GENERATOR GRILLE _ , tr' INFRARED HEATER w LABORATORY COCK . MAKEUP AIR UNIT OVEN _ i POOL HEATER j I'� E C: F' I �l -F T) ROOM/SPACE HEATER -,I ROOF TOP UNIT -.._+— fi TEST / I MAY l) ° :?: UNIT HEATER r.0 UNVENTED ROOM HEATER 61t1 -D-41C BEAR-METNI_ WATER HEATER r,, 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY r_47' 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 appication 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 comptance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ('' v PLUMBERIGASFITTER NAME: l,\-,<cc-ill"^ 411'1'r LICENSE# M /2t.1,, SIGNATURE COMPANY NAME: `3`f'l1 SP/L✓•CZ C--"•�. /'f1N� ADDRESS: V - 1.77•4'Al S732-4.1: CITY: J�4 y in/<el. STATE: rhfi ZIP: 62 5-6/ FAX: TEL: S0L; 77 L- /' CELL 77 Y Y,'/7 i/7u EMAIL: >,//s S r 3 3 u c-% % rr,.3//, C..,.y, MASTER CJ JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 0# PARTNERSHIP❑# LLC❑# _ vl v / c