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Home My WebLink AboutBLDG-23-001362 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1'1 CITY YARMOUTH MA DATE September 14,202 PERMIT# BLDG-23-001362 JOBSITE ADDRESS 79 MAYFLOWER TERR OWNER'S NAME Mary Shannahan G OWNER ADDRESS 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 1 FRYOLATOR FURNACE 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 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 ❑ OTHER OF INDEMNITY CI 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 Kenneth Thomas LICENSE# 11362 SIGNATURE MP Q MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: KENNETH W THOMAS ADDRESS. 31 FAIR OAK DR, CITY BREWSTER STATE MA ZIP 026312654 TEL FAX CELL EMAIL thomasplumbingheat1na,gmail.com S310N M3IA321 NV1d #1IIJ 3d $:33d ❑ ❑ 11W213d 3E11 SV S3A?JaS N011VOIlddV SIN]. oN seA S31ON N01103dSNI 1VNId AlN0 3Sl 2J0103dSNI 210d 3OVd SIHL S31ON N01103dSNI SVO HOl02i `''• 1 A AcHu E1'T UNIFORM APPLICATION FOR A,1 �,-� PERMIT TO PERFORM GAS FITTING WORK "Wr�a: CIT • - f'��N of r/1�C)L k MA DATE 9 1 PERMIT #. Z 3 - / 3 L v. 1 • -�: JOBSIT , DRESS WI )ti er tserr L . OWNER'S NAME' t' c'_, - f G OWNER ADDRESS TEL K.\ TYPE OROCCUPANCY TYPE COMMERCIAL EDUC ._ PRINT Ai IUI�AL ❑ RESIDENTIAL CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO APPLIANCES 1 FLOORS-+ SSM 1 ? 3 1 5 6 7 o 9 10 'I'I 2 I� 1, BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYC)LATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ------4 MAKEUP AIR UNIT F E. a E I V E OVEN 1 I 1 POOL HEATER - SEf-. 4 2022 ROOM ! SPACE HEATER ROOF TOP UNIT 1.r TEST RIIILDING uti-JART EENT . . • • • • BY — UNIT HEATER • , UNVENTED ROOM HEATER _ 1 WATER HEATER L- OTHER 1111 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES, IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE GE BY CHECKII4G 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 byChapter142 Massachusetts General Lawn, and that mysignature on this permit application naives this requirement. of the Massachusetts �, SIGNATURE OF OWNER OP, AGENT CHECK ONE ONLY: OWNER ❑ AGENT ❑ 7.1� I hereby certify that all of the details and information I have submitted or entered regarding this `� and that all plumbing work and installations performed under the permit issued for this application l ben co tr nd accurate to the best of my knowledge th edge �` Massachusetts State Plumbing Code and Chapter 142 of the General will in co pli ce wi all PE Went provision of the L Laws. ,lit9(y . ,e7 PLUMBER-GASFIT'f EP, NAME 4--ntle*Y.1". � Lj) 1 LICENSE # 1 (.36a SIGNATURE IMP MGF ❑ JP � - -. ❑ GF ❑ LPGI ❑ CORPORATION ❑ li PARTNERSHIP 0 # LLC Ott COMPANY NAME O S ' /i C ADDRESS . 4— 2D- ____y - ZIP _Weat_______ TE r--- 68. b - at, FAX CELL EMAIL t• t � ailb ' °, 'c I e 19114/ C (P—7( 1 (V.' ROUGHINSFECTIQr�r"TES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES •