Loading...
HomeMy WebLinkAboutBLDG-23-001366 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Iti-14 CITY YARMOUTH MA DATE September 14,202 PERMIT# BLDG-23-001366 ti= 4. JOBSITE ADDRESS 5 SYRITHAS WAY OWNER'S NAME MCLAUGHLIN LAWRENCE D G OWNER ADDRESS C/O MCLAUGHLIN KEVIN 15 DONNELLAN CIR WEYMOUTH MA 02191 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 • 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 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 El 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 brian hibbard LICENSE# 11977 SIGNATURE MP© MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. po box 429, CITY south dennis STATE IMA I ZIP 02660 TEL 15083982228 FAX CELL EMAIL I S310N M3IA32J NVld #1IWN3d $ 33d 0 0 111A213d 3H1 SV S3Ail3S NOI1VOIlddV SI1-11 ON saA S310N NO1133dSNI lVNl3 AINO 3Sfl 2J0133dSNI 2J0d 30Vd SIHl S310N NO1133dSNI SVO HJl02J