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HomeMy WebLinkAboutBLDG-21-007603 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �' ' CITY YARMOUTH MA DATE June 30,2021 PERMIT# BLDG 21-007603 JOBSITE ADDRESS 70 RAINBOW RD OWNER'S NAME KUSHI RAYMOND TR G OWNER ADDRESS T R&B L GARRITY 2012 IRR TRUST PO BOX 388 LEE MA 01238 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 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 1 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❑ 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 JOHN O'CONNOR LICENSE# 11191 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG( 0 CORPORATION 0#I I PARTNERSHIP 0# LLC 0# COMPANY NAME: JACK O'CONNOR PLUMBING&HEATING ADDRESS. 15 JAN SEBASTIAN DR,UNIT A5, CITY (Sandwich I STATE (MA I ZIP 02563 TEL FAX 15088887997 I CELL 15088331424 I EMAIL jackl Iackoconnorplumandheat.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 RECEIVED JUN 30 2021 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM G�ulr q�rvut-T v=t L n __ y CITY: Al P5i l/�r/)?trJ7�� MA. DATE 4 6 y 1I PERMIT# Dt-1�X- �1-06 ,G3 JOBSITE ADDRESS: 7(3 CZ\ Nn ' 'k.) ' ' ' OWNERS NAME: 6 1 rr t .7 y GOWNER ADDRESS: 73 a-4 rti • `'"" TEL:S OA 141 00'19J" FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY i NEWX RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCESZ 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 lil INFRARED HEATER w LABORATORY COCK _ MAKEUP AIR UNIT _ _ OVEN ,' POOL HEATER , ROOM/SPACE HEATER -J ROOF TOP UNIT ' 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 YES/ NO 0 If you have 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 I Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are - .nd accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will •: In••mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1----- PLUMBERIGASFITTER NAME: ' (-K 0(71/43 '" LICENSE#\ 1 ►'I NI SIGNATURE COMPANY `C NAME:Qr)L (-WI"r g l 1 /vn.,ADDRESS: / s 0 S �"1" Sc'b2S'L j�'v (3CITY: rC't/�LN'Cr` STATE: ZIP: �1S �3 FAX: ��ce.bc�`� TEL:S '�iS� ' �ij2 CELL:3 L�L(7 .D 3c77 EMAIL: 1-.�J( i( (}C.1n1,.-p J\J�1 A nl0}-t eA)' ( in MAS JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# c Sri 1i 4. ADU2c-SS : -