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Home My WebLink AboutBLDG-22-006529 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w" CITY YARMOUTH MA DATE IMay 12,2022 I PERMIT# BLDG-22-006529 =..� JOBSITE ADDRESS 33 PLEASANT ST OWNERS NAME (Jesse Connell G OWNER ADDRESS 33 PLEASANT ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE 1 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY 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 IEugenijus Jagminas I LICENSE# 8820 SIGNATURE MP©MGF❑JP❑ JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: EUGENIJUS R JAGMINAS ADDRESS. 34 ELIJAH CHILDS LN, CITY ICENTERVILLE STATE MA ZIP 026322112 TEL I FAX I I CELL I I EMAIL CAPEANDISLANDSPLUMBINGWGMAIL.COM SALON M3IA3H NVId #±II10d3d $:33d ❑ ❑ 111"183d 31-11 SV S3AN3S NOIIVOIlddV SIHl oN saA S310N N01103dSNI IVNId AlN0 3Sf U0103dSNI ZIOd 39Vd SIH1 S3 LON N01103dSNI SVJ HJf102i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4= CITY (�ti'TH AKlAUtY1 MA DATE 5 21- PERMIT # • JOBSITE ADDRESS 33 PAS AILII OWNER'S NAME CO i../ki Ll. G / OWNER ADDRESS �� ?►� >�� t�T STREET TEL1J�(5 ."/)'��' 0C, 17 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL, PRINT CLEARLY ; r it i, RENOVATION:' REPLACEMENT: n PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES Z 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 I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 7PNO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY n 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 AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac irate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co i.nce /h all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /4 ' PLUMBER-GASFITTER NAME CA) Qe .a jUS TA-604iN/ LICENSE # 351 L; SIGNATURE MP ❑ MGF JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERS. ' I # LLC # Elk-1110-i COMPANY NAME tit'i -k, , ? VL7'1r� �L ADDRESS 111 (� CITY SA6VW0t-E12kPc-* STATE t1i ZIP Oz 5(k - TEL 5th - �� 3 FAX CELL 5°S ` � f 6822 EMAIL C tw LW//) L/-}"hf IxpL E*!13/).4-- C'Nhz/t. (Ql/ fi Z etc1414-icito1/41 5b'" -- 16 t l b = t7oick;