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HomeMy WebLinkAboutBLDG-22-004399 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK V CITY YARMOUTH MA DATE _February 08,2022 PERMIT# BLDG-22-004399 JOBSITE ADDRESS 11 SWAN LAKE RD OWNER'S NAME MACPHEE ROBERT G OWNER ADDRESS 59 ELIOT RD ARLINGTON MA 02174 TEL -- TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL III PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO FIXTURES FLOORS BSM 1 2 3 4 5 6 , 7 8 9 i 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 I 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 0 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 Kevin Sweeney LICENSE# 20883 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG! 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: Sweenev's plumbing services ADDRESS. 167 Eaton Lane, CITY Brewster STATE MA ZIP 02631 TEL FAX CELL 7745785922 EMAIL 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