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HomeMy WebLinkAboutBLDG-21-006575 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK It'k � - CITY YARMOUTH MA DATE May 13,2021 PERMIT# BLDG-21-006575 `' JOBSITE ADDRESS 1 MAUSHOPS PATH OWNERS NAME KENNEDY AGNES M(LIFE EST) G OWNER ADDRESS C/O JOANNE M KENNEDY 1 MAUSHOPS PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 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 1 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 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF 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. 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 Peter Hassett LICENSE# 11682 SIGNATURE MP© MGF ❑ JP❑ JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: PETER J HASSETT ADDRESS. 8 Skipper Lane,Hassett Plumbing&Heating Inc. CITY Yarmouth Port STATE MA ZIP 02675 TEL FAX CELL EMAIL peterjhassett(a)gmail.com 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -"� — CITY Yarmouth MA DATE 5/13/2021 PERMIT # JOBSITE ADDRESS'1 Maushop's Path _._,._,,�� OWNER'S NAME Kennedy _� TEL G OWNER ADDRESS Kennel ' " " TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT REPLACEMENT: v PLANS SUBMITTED: YES L�,: NO CLEARLYNEW: RENOVATION: APPLIANCES Z FL00 RS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - k BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE — GENERATOR V 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 INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES v 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 AGENTmy certify that all of the details and information I have submitted or entered regarding this application inre e and accurate� Pttott1h sttof ion knowledge the dge I hereby c lu and that all plumbing work and installations performed�ofdthethe Ge permiter Laws.issued for this application will P J Massachusetts State Plumbing Code and Chap # 11682 SIGNATURE PLUMBER-GASFITTER NAME Peter J. Hassett _ .�� �i3 __ LICENSE _.��_ ..� ��` I CORPORATION # 3506 PARTNERSHIP #' ¢�. LLC # : ,_. MP MGF _ JP JGF �. LPG — COMPANY NAME: Hassell Plumbing and Heating Inc. ADDRESS 8 Skipper Lane _ _++ o.... CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 EMAIL peterjhassett@gmail.com - -