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HomeMy WebLinkAboutBLDG-22-004751 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK u �: CITY YARMOUTH MA DATE February 25,2022 PERMIT# BLDG-22-004751 JOBSITE ADDRESS 61 OUT OF BOUNDS DR OWNER'S NAME CAFFREY PATRICIA E G OWNER ADDRESS 61 OUT OF BOUNDS DR SOUTH YARMOUTH MA 02664 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ 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 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 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 ❑ 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 Joseph Madden LICENSE# 34558 SIGNATURE MP❑MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME IJ.M.MADDEN COMPANY I ADDRESS. 115 Perrys Way, CITY I Harwich I STATE MA ZIP 02645 TEL FAX 5555555555 CELL 17747223545 I EMAIL Iinfosmaddencompanv.biz S310N M3IA3ti NYld #±I1A2i3d $:333 ❑ ❑ 1I1A1213d 3H1 SV S3A213S NOLLVOIlddV SIH1 oN s9A S310N NOI103dSNI 1VNId AINO 3Sl 210103dSNI 2IOd 39Vd SIH1 S310N NOI103dSNI SVO H9f1021 '_� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `(CPkik41 MA. DATE: Lf YN/L - PERMIT# t, ,,55",� CITY: - - / �'L� OWNER'S NAME:g..�1 C:e,'«.. C xe�/ JOBSITE ADDRESS:l�l Ov� r� `1 1U�rr► S I GOWNER ADDRESS: TEL: `PK"30 4 - 1C g'6 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Er PRINT El CLEARLY NEW:❑ RENOVATION:Er REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO APPLIANCES-1 FLOOR Bsmi 1 1 2 3 4 " 5 6 1 7 8 9 10 1 11 12 13 1 14 BOILER .1111.111111.11111 �1 _ BOOSTER - _'__ C MUM CONVERSION BURNER �_= COOK STOVE DIRECT VENT HEATER __ DRYER _� 1 __I ' 1111.111111111111111111111111111 FIREPLACE FURNACE '_ �� GENERATORGRILLE I IMIMMIll 11111111 MOM1 INFRARED HEATER IIIIIIIIIIMIIIMIIIIIIMMIIIIIMIIII I _ LABORATORY COCK �_' _' MAKEUP AIR UNIT 1 �� OVEN _ POOL HEATER ROOM I SPACE HEATERMill i ROOF TOP UNIT 1 __ TEST I IIIIMIIIIIIIIIIIIIIMla UNIT HEATER I i UNVENTED ROOM HEATER _� WATER HEATER IIIIII liaIIIMIIINIIIIIIIIIIIIIIIZIIMMI INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ZIO ❑ appropriate If you have checked YES,please indicate the type of coverage by checking the FP Priate 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 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate,ta 11)9 best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will'rJe in complce,�j I Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. fi _� _--, ( .. . �.-:; ,�'�'`SIGNATURE PLUMBERIGASFITTER NAME:` :,:r'} /1/ � G•''' LICENSE# `:71..• '�. COMPANY NAME: f>,1� ;tfi�,,-:, " I'/i ( i :'*iADDREsS:/ :� :�,�/C, -••�' 1 % CITY:;•.� ei.J G!r\ STATE: d f, ZIP: u- FAX: I TEL: )) ( • r-• -c •JcCELL: EMAIL: ,n .) . t,?�1:�;.�f:l`c:r ti zif+�, -4_&'' t MASTER D. JOURNEYMAN l=f LP INSTALLER 0 CORPORATION dfi. f.)� PARTNERSHIP❑# LLC 0# Ct/ 9'CO