HomeMy WebLinkAboutBLDG-22-004927 ..\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
• )-'j CITY Yarmputh port MA DATE 1/31/2022 PERMIT# 2-' 'I
JOBSITE ADDRESS 11 Longfellow Drive OWNER'S NAME Josh Woolward
GOWNER ADDRESS 11 Longfellow Drive TEL 508-367-1069 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: RENOVATION: REPLACEMENT: , 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/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER 1
OTHER -
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES , NO
I IF YOU 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: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 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 accu e to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in comp' e wit Pe inen rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME MARK MORAN LICENSE#20786 SI NAT E
MP MGF JP + JGF LPGI CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME:MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE
CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934
FAX CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.COM p/ta, 5e/v7tx.c /
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
1