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HomeMy WebLinkAboutBLDG-22-002358 1.,/ ;I-1,dret.-rh _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i ° CITY YARMOUTH MA DATE October 25,2021 PERMIT# BLDG-22-002358 JOBSITE ADDRESS 63 ABELLS RD ]OWNER'S NAME SHEA ROBERT D G OWNER ADDRESS SHEA CARLA 63 ABELLS RD SOUTH YARMOUTH MA 02664 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 ❑ OWNERS 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 Jordan Medeiros LICENSE# 16366 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Jordan's plumbing ADDRESS. 873 tradewind st, CITY New Bedford STATE MA ZIP 02740 TEL 5088639518 FAX CELL EMAIL S310N M3U13b NVld #J V J d $ :33d ❑ 114Vi3d 3H1 SV S3A2:13S NOI1VO1lddV SI1-11 oN seA S310N NO11O3dSNI 1VNId )C1NO 3Sfl wl03dSNI H03 3OVd SIHI S310N NOI133dSNI SVO Fiona'