Loading...
HomeMy WebLinkAboutBLDG-22-003650 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK klfCITY YARMOUTH MA DATE December 30,202'PERMIT# BLDG-22-003650 JOBSITE ADDRESS 41 NAUHAUGHT RD OWNER'S NAME CHIN JARROD J G OWNER ADDRESS LAWRENCE COLLEEN L 30 HAWTHORNE RD MILTON MA 02186 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF 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. 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 gilmore LICENSE# 13699 SIGNATURE MP©MGF❑JP El JGF❑ LPGI ❑ CORPORATION❑# _ PARTNERSHIP ❑# JLLC❑# COMPANY NAME: PLEASANT BAY PLUMBING INC ADDRESS. CITY BREWSTER STATE MA ZIP 02631 TEL FAX CELL EMAIL PLEASNTBAYPLUMBINGUUtCOMCAST.NET S3 LON M9IA J NVId #II1/0:13d $ 33� ❑ ❑ 11110:13d 31-11 St/S3/1213S NOI1VOIlddb SIHL oN saA S310N NOI103dSNI 1VNI3 K NO 3Sft W103dSNI NO3 3OVd SIHI S310N NOI103dSNI WO HJf10b if 9. ° e. ::.,L.,:` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ItZWeP CITY C-\ibitt>1)-40044 . MA DATE L2 J2'+ /2 PERMIT 2 Z 36 5Z JOBSITE ADDRESS Lit AJAULA \ 4 (2.;\ _ NAME N. ,ME C ki(k) Josc 4Z.-1204) GOWNER ADDRESS TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL E RESIDENTIAL K CLEARLY NEW: E RENOVATION: v, REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO APPLIANCES FLOORS-+ BDul 1 ' BOILER 2 -1 5 6 7 8 9 11 l'I 12 I; 1- BOOSTER CONVERSION BURNER • COOK STOVE 1 DIRECT VENT HEATER DRYER, 1 r i FIREPLACE - i 1 FRYOLATOR ---� FURNACE GENERATOR GRILLE �J INFRARED HEATER LABORATORY COCKS . I MAKEUP AIR UNIT ROVENE POOL HEATER - ROOM ! SPACE HEATER ROOF TOP UNIT - �E� TEST . UNIT HEATER _. .._. . . •gu � IN:, uHrHkTNIEL_NT --- Rv. s [INVENTED ROOM HEATER - _ -- WATER HEATER 1 OTHER i _ I I I . I i INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements at [IIIIGL. Ch. 142 YES K 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 Cha Massachus.ei:ts General Laws, and that mysignature on this permit application v►raives this requirement. Y pter 142 of the SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT El `=1; I hereby certify that all of the details and information I have submitted or entered regarding this application `— and that all plumbing work and installations performed under the permit issued for this application will be nac� true and Occur ` to he best of my I;m a Pe ent provision o fthef edge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE # 1. 9 `NATURE MP X, MGF ❑ JP ❑ JGF ❑ LPG! ❑ CORPORATION 1g:1 F 3644g' PARTNERSHIP1 ❑ fir LLC 0 # COMPANY I,IAMEPLitciA Qikrat C ,.3a6 �� —Li C. _ ADDRESS 4(-- C's L - 9-&/-16- 3 C6 LA.) :- CITY ___Eti____ STATE ZIP O�Co TEL ?7�f ?L2 L __ FAX CELL EMAIL ROUGH GAS INSPEC I IOP� d0` 'ES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT# PLAN REVIEW NOTES