HomeMy WebLinkAboutBLDG-21-005582 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
in CITY YARMOUTH MA DATE March 29,2021 PERMIT# BLDG 21 005582
JOBSITE ADDRESS 17 SNOW BROOK RD OWNER'S NAME JONES EDWARD F JR
G OWNER ADDRESS 204 I ST SOUTH BOSTON MA 02127-4166 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0
FIXTURES FLOORS—* BSM 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 1
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 1
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 El 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 0 MGF ❑ JP 0 JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME: JOSEPH M HALLORAN ADDRESS. 29 Forest Glen Rd,
CITY Hyannis STATE MA ZIP 026012537 TEL
FAX CELL EMAIL sowdawq@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
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JOBSITE ADDRESS ! 7 Show U2c OWNER'S NAME /47A/c ! a/V- 7
GOWNER ADDRESS 36 CL�pp Si. U(19/ t Al.) �6 M . TEL 7 ` 7 Fla-
TYPE OR / 0�1J'/°L
PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL IYI-----
CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:Lid PLANS SUBMITTED: YES❑ NO❑
APPLIANCES 1 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 I SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER /
OTHER G,9 s 7k sT /
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 20 ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Er- OTHER TYPE INDEMNITY ❑ BOND El
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 El AGENT ❑
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 a ra the knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian 'h rtin i of the
Massachusetts State Plumbing Code and Chapter 142 of e General Laws.
PLUMBER-GASFITTER NAME Toy If 04-) GRAti LICENSE#/On/ SIGNATURE
MP Er MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION El# PARTNERSHIP El# LLC El#
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i /�COMPANY NAME�oSLp►`^ hi') e4�/ ��u�i �'v ADDRESS �-� r L O e`f�6 It ../ l�/ o/f 0/
CITY [I `f/j/�Ai 15 STATE /, ZIP d Z 6-6 l TEL S d S` - `d -2 d 7
FAX / CELL EMAIL 5 O'Lv O4 v/ Cfiy c45/` A/jjr