HomeMy WebLinkAboutBLDG-22-005408 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
r
CITY YARMOUTH MA DATE March 28,2022 J PERMIT# BLDG-22-005408
`(' JOBSITE ADDRESS 170 PLEASANT ST OWNER'S NAME SPENCER ABBOTT K JR TRS
G OWNER ADDRESS C/0 ACHESON ELEANOR D 425 8TH ST NW APT 1129 WASHINGTON DC 20004 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO El
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
GRILLE 1
INFRARED HEATER
LABORATORY COCKS
•
MAKEUP AIR UNIT
OVEN
•
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST 1
•
UNIT HEATER
•
UNVENTED ROOM HEATER
WATER HEATER
OTHER 1
OTHER DESCRIPTION:Outside Firepit
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER OF INDEMNITY CI BOND El
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 Eric Whiteley LICENSE# MA SIGNATURE
MP❑ MGF El JP El JGF El LPG! El CORPORATION El# PARTNERSHIP El# Lc El#
COMPANY NAME: W Vernon Whiteley,Inc ADDRESS. PO Box 1266,
CITY West Chatham STATE MA ZIP 02669 TEL 5089451100
FAX CELL EMAIL
S310N M31A321 NVId
#1IW213d $.33d
111U3d 3H1 SV SAES NOI1V0IlddV SIHI
oN saA
S310N N01103dSNI 1VNId AINO 3Sf1 N0103dSNI 210d 30Vd SIHI S310N N01103dSNI SVO HJflON