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HomeMy WebLinkAboutBLDG-22-005582 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i;1 +,—e CITY YARMOUTH MA DATE April 01,2022 PERMIT# BLDG-22-005582 JOBSITE ADDRESS 16 PINE ST OWNER'S NAME MCNALLY JAMES B G OWNER ADDRESS MCNALLY MARY 46 MT VERNON AVE BRAINTREE MA 02184 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO©' 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 2 FRYOLATOR FURNACE GENERATOR GRILLE 1 • 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:Gas line to fireplace insert. Underground direct bury line from meter to 1 outside fireplace and 1 grille hookup. 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 ❑ 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 John English LICENSE# 16764 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 32 Winslow drive, CITY Mashpee STATE MA ZIP 02649 TEL FAX CELL EMAIL S310N M31A3a NV-Id #1IWTJ3d $:33d ❑ ❑ 110183d 11.1.SV SAS NOIlV3IlddV SIHI ON SaA S310N NO1103dSNI IVNId AINO 3Sfl a0103dSNI dOd 30Vd SIH1 S310N NO1103dSNI St/0 HOflOa