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Home My WebLink AboutBLDG-22-005249 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE (March 21,2022 I PERMIT# BLDG-22-005249 — JOBSITE ADDRESS 120 CAPT BLOUNT RD OWNERS NAME 'CHRISTIANSEN RODGER A G OWNER ADDRESS CHRISTIANSEN SUSAN T 20 CAPT BLOUNT RD SOUTH YARMOUTH MA 02664 TEL I TYPE,OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/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❑ 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 Sean Oleary LICENSE# 13057 I SIGNATURE MP❑MGF❑JP❑ JGF❑ LPG( ❑ CORPORATION 0# PARTNERSHIP ❑n LLC❑# COMPANY NAME: SEAN F OLEARY ADDRESS. 2 FABYAN RD,2 FABYAN RD CITY Plymouth STATE IMA I ZIP 023602390 TEL FAX CELL EMAIL advantaoeheatac(o)omail.com ,O, . S310N M3IA321 NVld #J IA1 I3d $ :333 ❑ ❑ lIW2i3d 3H1 SV S3/1213S NOIlVOIlddb SIHI oN seA S310N N01103dSNI 1VNIH /LINO 3Sf1210103dSNI 2J03 3OVd SIHI S310N NOI103dSNI SVO HOf102J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ej CITY )14DC.Is ii ;s+" lick DATE 3`-/e ova PERMIT JOBSITE ADDRESS �O CAPT1- . t >UJ_/(GOWNER'S NAME CN -, OWNER ADDRESS `` if TEL 7$��Sj�4S"p6 TYPE OR FAX PRINT CLEARLY ��,( OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL�� NEW:rij RENOVATION; ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 7 FLOORS-4 SSM 1 2 3 1 5 6 7 BOILER 9 1i1 11 12 13L. 1! BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER ` ____ FIREPLACE ---' FP,YCiLATOR FURNACE -"— GENERATOR GRILLE i-- INFRARED HEATER ! R 4 C E 1- E P- LABORATORY COCKS MAKEUP AIR UNIT OVEN j 4i� 1 6 LLlL POOL HEATER - -. ROOM I SPACE HEATER ROOF TOP UNIT , TEST • , UNIT HEATER - . _. .._.... .._-.Cptf,- UNVENTED ROOM HEATER • WATER HEATER T`__-- OTHER T UA t �)-c�LZ k,�Z _1_ , . ,______E___ 1 VERAGE I have a current liabili insurance policy or its substantial equivalent INSURNCE O which meets the requirements of MGL.Ch.142 YES I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CO1► �D ❑ E E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ 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 CHECK ONE CINL OWNER ❑ A ❑ I hereby certify that all of the details and information I have submitted or entered regarding this application are true accurate to the be,- my and that all plumbing work and installations performed under the permit issued for this application will be in comp knowledge Massachusetts State Plumbing Code and Chapter 142 of thereneral Laws. with all Pe) ent sion of the LU // PLUMBER-GASFITTER NAME �' LICENSE# 3957 SIG TU MP ❑ MGF❑ JP ❑ JGF LJ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC COMPANY NAME PU T HPT-'� F L r(Jc . ADDRESS 2_ 4`J` ❑# CITY PLm°vl Ct STATE 144'• . ZIP Og5j66 TEL 5te)6 >57 WOO FAX CELL EMAIL�� `61i?Ir M-1 j-CP 1 Sb ROUGH GA-INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT #t PLAN REVIEW NOTES