HomeMy WebLinkAboutBLDG-20-002132 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
Yarmouth Port
n— CITY MA DATE 10/10/19 PERMIT# 6- -t21,5A
JOBSITE ADDRESS 105 Wianno Road OWNER'S NAME Eileen McCarthy
GOWNER ADDRESS 105 Wianno Rd Yarmouth Port MA 026751L 978-793-1116 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIAL
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED:YES❑ NO❑
APPLIANCES 7 FLOORS-. BSA 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
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
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES® NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING 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 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
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. 94.01.71icinsiut.4.&
PLUMBER-GASFITTER NAME LICENSE#'3O�C SIGNATURE
MP❑ MGF❑ JP❑ JGF® LPG!❑ CORPORATION❑# PARTNERSHIP❑# LLC❑#
COMPANY NAME McDonnell Mechanical Services,Inc ADDRESS 79 School Street
CITY W Dennis STATE MA Zip 02670 TEL 508-394-0005
FAX 508-394-5050 CELL 508-246-3152 EMAIL barbara@mcdonnellmechanical.com