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HomeMy WebLinkAboutBLDG-22-001290 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �, CITY YARMOUTH MA DATE September 06,202 PERMIT# BLDG-22-001290 11 - JOBSITE ADDRESS 5 NEW HAMPSHIRE AVE OWNER'S NAME FLANAGAN FAMILY 2008 IRR INCOME TRUST G OWNER ADDRESS C/O FRANCIS FLANAGAN 23 LEEMOND ST WILBRAHAM MA 01095 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:D REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO El 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 1 FRYOLATOR FURNACE 1 , GENERATOR , GRILLE 1 , 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF 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 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 Gary Jones LICENSE# 8890 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Gc Jones Plumbing&Heating ADDRESS. 12, CITY West Yarmouth STATE MA ZIP 02673 TEL FAX CELL 5085092725 EMAIL S31ON M3IA321 NVId #1IIN2l3d $ 33d ❑ ❑ . VII 3d 3H1 SV S3ASSS NOI1tl01lddtl SIHI oN saA S310N NO1133dSNI 1VNId AINO 3Sf1 a0133dSNI 210d 30Vd SIHI S31ON NO1103dSNI SVO HOf1021