Loading...
HomeMy WebLinkAboutBLDG-22-002635 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 09,202'PERMIT# BLDG-22-002635 JOBSITE ADDRESS 77 BAXTER AVE OWNERS NAME STEERE JOHN CALVERT G OWNER ADDRESS C/O ROBERT C STEERE P 0 BOX 7551 CUMBERLAND RI 02864 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 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 1 DIRECT VENT HEATER DRYER 1 FIREPLACE FRYOLATOR FURNACE 1 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 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 0 OTHER OF INDEMNITY 0 BOND ❑ OWNERS 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 John Braddock LICENSE# 16092 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: JOHN E BRADDOCK ADDRESS. IN GARNER AVE, CITY 'JOHNSTON ISTATE RI ZIP 029192308 TEL FAX I I CELL I I EMAIL liicon94anme.com S31ON M31Aal NVld #J tN 3d $ :333 ❑ ❑ II01213d 3H1 SV S3A2l3S NOIIV011ddV SIH1 ON Sail S310N NOIL03dSNI 1VNId AlNO 3Sfl?:10103dSNI 2103 3OVd SIH1 S310N NOI103dSNI SVJ Honai . - - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ;. yi�-� ry �� IIz .'•'r•.• ,.1 ! C I I 'r ,, M A D A I I. '`..9 -..__t)- PERMIT N (; ,I ;,f.,l)h( OWNER'S NAME. Roi7 _)1 'c � /�- -cam n� ti IELy01 - 63g -- ? 314,FAX i 1 Pi.. Olt L. RESIDENTIAL PRINTt)OCCUPANCYNCY I YI'I C:O�i1ML.RCIAI. �� [DUCAI-ZONA ( 1.1. 'It1.1 NI vi I._.I Ill-NOVAI ION K) REPL_ACE. ML.N 1.1 Li PLANS SUBMITTED: YES NO Z] • APPI IAN S 1 i[..00RS l.iSM 1 1 1 3 4 5 6 _1 -. 0 9 10 11 12 13 14 [ l3ollLk BOO , ; ; i� - . . - - ------ - ECOJr, '' ' I - --- --t __ - - -. ,- --_. ,. �- - --- ------- _ I)I:'t I I — I„i I; . . • ,., l - - , ,,,,, , ,), ..,., •: „„ , , I ,,,,,,„,, _ . , _.,._.______ _______. ____ __,____ , _ ____, . _ / _ . , GI. NI ;.J,.i U R i i _._._ GRIL 1 E INI RAM I) Ili Al l R _ _ . . .._ _..___ __.-_._...___ __—_._-...___-._._-__. - _ ____-- __ I -f - i MAKI uP ir: UNI i - --.._.._ . -_ ..__..._ -__-•_ ---1.--. OVEN 14O0L 1 it A I 1; ___ _ _ - 14.)U1 Hi' t.JNi 1 --I— _------------ ------..-_---._._-.-__--_-----..___.-_—..__ _.-_.. __--_----__.-_. B U L D I N Q D E PA RT M N T UNI I Ili. All'. i� -.._.__, By: 1 UNvI NIII) ROOM l WAFER E-I1 ----- ^r�1l c ;' 11t•�,I f 1. ; ._.. r.. . • --- -- INSURANCE COVERAGE I have a cutteilt liabilq.insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Prj NO 1 1 I IF YuU U:Itt•CKt U Yl `.i, PLEASE INDICA-OE I IIL IYPt=. OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage redutt ed by Chapter 142 of the Ma';sac:ilttSettS Genet al Laws, and that my signature on ails permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT L�! ' iu:,r,,A1 i RI.. Of UWNI.k OR ACL NI - - I t►ura' L.0lily that ail of the details and inionnatrort I have submitted or entered regarding this application are true and accurate to the best of my knowledge and tlr,-,t .,II piurHorny wuth atici installations pertorme.d under the permit issued for this application will be in compliance • all P men rovision of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. ^'` PI UMIil N.( ,A`.-diI II I: NAME .1 OIf 8 rfr-noe)Ge, LICENSE # S ,z,C SIGNATURE ^,r',i ' '.i.cJ L__' J ' LJ J(...il L_- j I I 'i ;1 i_ l,I CORPORATION ❑ # PARTNERSHIP [1 II LLC 0 N E U M L''i N r 1V.'l r'i11 ADDRESS --- 4 .__ ,6-�frr/ k..( jleu A__. • • • • ••• • • • • ..__.. .. ...... .. _.}.� t:i i t J O 1+-0 i 1--) r; I A f E r n� t /i I' 0 -2- 9 i °l i-E-t 0 t =c 7 " Jf 41 .-LI I !;X ©1 ` .2-- 31 ' 36 7.d c 'i I i y(,' I c----7 pi 2• I..MAIE WCuIJ 9 `"�. .._ c —LQ --