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Home My WebLink AboutBLDG-21-006732 — 4. t. /' i C _ J' / ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 k CITY YARMOUTH MA DATE May 20,2021 PERMIT# BLDG-21-006732 li ,• "w JOBSITE ADDRESS 47 POWERS LN OWNER'S NAME DOBLE GEORGE L G OWNER ADDRESS DOBLE JUDITH A 6 MANOR AVE BURLINGTON MA 01803 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 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 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 1 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 Michael Welch LICENSE# 17607 SIGNATURE MP❑ MGF ❑ JP El JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL L WELCH ADDRESS. 991 OAK ST, CITY W BARNSTABLE STATE MA ZIP 026681525 TEL FAX CELL EMAIL none ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES 4) (cc- CoD - "76' 7 eS' iza)(a C 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �'= CITY MA. DATE Or ( `I 21 PERMIT#BI-DG -2(-00(c 7 3 Z JOBSITE ADDRESS: '{L7 igi'14-Lti V4P�0--- OWNER'S NAME: ( 0 GOWNER ADDRESS: 1 7 e ' er WY-1—c— TEL: FAX: TYPE OR ' OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL — PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT PLANS SUBMITTED: YES❑ NO❑ APPLIANCES FLOOR Bsmt 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 k INFRARED HEATER j 2 LABORATORY COCK MAKEUP AIR UNIT t OVEN POOL HEATER ROOM/SPACE HEATER .l ROOF TOP UNIT fi TEST UNIT HEATER 1 u 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 YESeP^NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY .6 i 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 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurafe to the best of my j Knowledge and that all plumbing work and installations performed under the permit issued for this application wT-be In mplia1kce with all P nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` - PLUMBERlGASFITTER NAME: VLt\(Z, LICENSE# f ?6G> SIGNATURE COMPANY NAME: Q, \ f -Qc-tk P 4-4(7DDRESS: 9 /( `. CITY: L &C J l -Or' STATE: kkt. - ZIP: 0 2-6 6 FAX: TEL: ram,g- 77 JS lv CELL:_ EMAIL: MASTER❑ JOURNEYM.ANal LP INSTALLER❑ CORPORATION❑# PARTNERSHIP[]# _ LLC❑# C h76,ce. ADLtee-SS