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HomeMy WebLinkAboutBLDG-22-006444 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'tzftCITY YARMOUTH MA DATE 'May 09,2022 I PERMIT# BLDG-22-006444 JOBSITE ADDRESS 359 ROUTE 6A OWNERS NAME rBRITT ELIZABETH L G OWNER ADDRESS 359 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES❑ 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY❑ BOND 0 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 'Spencer Hallett I LICENSE# 16224 SIGNATURE MP©MGF 0 JP❑ JGF 0 LPG' ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: (SPENCER HALLETT I ADDRESS. 1381 Old Falmouth Rd Unit 36, CITY IMARSTONS MLS I STATE MA ZIP 026481372 TEL I FAX I I CELL I I EMAIL Isue(Shallettplumbing.com S310N MJIA32J NV1d #±I VJ it d $ :333 ❑ ❑ 11INa3d 3H1 SV SSAa3S N011v3Ilddv SIHI oN seA S310N NO1103dSNI IYNI3 AlNO 3Sfl 210103dSNI b03 39Hd SIHI S310N NO1103dSNI SVO HJl0H SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R E r = E_D _ _�_... .._._�_. .4.v�� r ---CIT" i _ _ _ 1 MA DATE[ 6719—, 5 2 --I PERMIT # 2-1- 6 ` 4(1 MA 2Q72JOE'SIT ADDRESS ra,,,vi cki n 5,i- G OWNERS Ni- 1E 5------ --e_Cuj--- 47 Q. -f1.d..... � BU I L DI N ART E ADDRESS 5 I� ,� V �Q L1 C TEL FAX i , ._ B y __ TYKE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL fl RESIDENTIAL 0 PRINT CLEARLY NEW: Z RENOVATION: E..= REPLACEMENT: I...,wl PLANS SUBMITTED: YES Li NOD APPLIANCES 1 FLOORS-► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER :,...., BOOSTER j,._,., -_. ----- ___M_..__ ( it f [�__._ , ___. T CONVERSION BURNER (____. - ._ ___ ,(r , COOK STOVE .--1 ' -—-- ------- ---1.il - - ---- : i DIRECT VENT HEATER r 1 - �__.. I ,-..r____ .r,._,_ __,_._. _, _ _,.,, ___ail_ __._•1 DRYER [ ( �.,.,. ... I . FIREPLACE -. __ (_..,.. __. ... ...1_..__....., , ... t- ,_ft._.. .. - . .-J FRYOLATOR ' _ ... FURNACE GENERATOR -- I .r ., .._. ... ... ..... , �I GRILLE _ . , __ - ,... L , - -. .. INFRARED HEATER ' ,' , - , , ', -- - : - ,___. _ .____ . LABORATORY COCKS r �. �,-' . _. .. MAKEUP AIR UNIT OVEN POOL HEATER i ROOM / SPACE HEATER ROOF TOP UNIT 1 - __ .,..TEST I _.-----= ----- i - {.- - ... ... 1 -- UNIT HEATER UNVENTED ROOM HEATER T WATER HEATER _..,, n_T.__] __ .__ z. ., ____.1 .,_____ _____, OTHER _ .__ -__..-.. _ ._.... I . ._ _ ,_ ._ ( ______ 11111111.0111.111111111111.111111111111M ..,..— 111111111111 -- - -I --------, - ------ II IIIIIMIIIINIIIIIIIIIIIIIIMIIIIIIIWIIIIIIIII - I. -- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ��.. NO El I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY IVrt OTHER TYPE INDEMNITY Fli BOND L.j 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 0 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 .•• accurate •.. - •est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn• :.I.%- -1"'ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Spencer Hallett LICENSE # 16224 - SIGNATURE MP .�. MGF [7.1 JP JGF Li LPG! 0 CORPORATION v # 3834 I PARTNERSHIP # LLC # , COMPANY NAME: Spencer Hallett Plumbing & Heating, Inc, I ADDRESS 381 Old Falmouth rd, Suite 36 I CITY Marstons Mills STATE MA ZIP 02648 TEL 508-428-6080 FAX 508-428-7991 I CELL ' EMAIL sue a@hallettplumbing.com I