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HomeMy WebLinkAboutBLDG-23-004577 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 17,2023 PERMIT# BLDG-23-004577 JOBSITE ADDRESS 147 MAYFLOWER TERR OWNER'S NAME TALLMAN BRADFORD L JR G OWNER ADDRESS TALLMAN ANNE S 147 MAYFLOWER TER SOUTH YARMOUTH MA 02664-1120 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 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❑ 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 Paul Viera LICENSE# 26989 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION 0# PARTNERSHIP El# LLC El# COMPANY NAME PAUL A VIERA ADDRESS. 3 SHADY DR, CITY HARWICH STATE MA ZIP 026452930 TEL FAX CELL EMAIL paulsplumbing20(@vahoo.com ( RECEIVED btD6 L3-ct 7 FFB 16 2023 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTR G WORK w.n 2 • 'a�F.RTMENT .�=,r CITY: y rr tint k.1 L-, MA. DA L>f tp. o a 3 t ;Mir " _ JOBSITE ADDRESS 19 i Mal f-1 c ; 1 S NAM:: A IN toe ILA 11 MAO �j1�13 G OWNER ADDRESS'1111 Mjd 1Pt NAY-AO 0, _TEL 7 Ai 7 d �� TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIO@ITUL PRINT CLEARLY NEW','® RENOVATION:0 REPLACEMENT:❑ PLANSSUBMrTTED:YES❑ NO❑ APPLIANCES? FLOOR Burt 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 ?l{ FRYOLATOR FURNACE GENERATOR GRILLE t. INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT O OVEN POOL HEATER ROOM!SPACE HEATER J ROOF TOP UNIT T TEST Z UNIT HEATER tki UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YESS(NO❑ If you have checked 10,,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCEPOLICY,1 OTHER TYPE INDEMNITY❑ BOND 0 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 Jj 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 to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for tics applkhtlon MU be In appliance wlip.a l PertInent provision of the Massachusetts State Plumbing Code end Chapter 142 of the General Laws. � PLUMBERIGASFITTERNAME \l t�?A V le\a �CLICENSE# Z�I�`_' SIGNATURE CITY COMPANY 4,(J�.1 STATE'�Af7DRESA. ZIP. (J � FAX TEL: 7 '52S t9i2 c Z77453511SS92- EMAIL: Dakls?lti)b41 c) 2° •.patio, covr^ MASTER❑ JOURNEYMAN'] LP INSTALUER❑ CORPORATION❑# PARTNE SHP❑# LLc 0 a cMrNL A Lti2e5s:,n,14. �b' f a r C.OW1