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HomeMy WebLinkAboutBLDG-22-006828 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 24,2022 PERMIT# BLDG-22-006828 JOBSITE ADDRESS 17 NARROWS LN OWNER'S NAME KING DENISE P G OWNER ADDRESS 7 COLELLA FARM RD HOPKINTON MA 01748 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 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 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 LESTER WADE LICENSE# 4569 SIGNATURE MP❑MGF©JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: LESTER J WADE ADDRESS. 22 CAPTAIN ISIAHS RD,22 CAPTAIN ISIAHS RD CITY ICOTUIT I STATE MA ZIP 026352702 TEL FAX CELL EMAIL infotccipgenerators.com S310N M31A323 NVld #±IIAJH d $ :33� El El 'Mad 3111 SV S3M3S NOLLVOIlddV SIHI oN seA S31ON NO1103dSNI 1VNId KINO 3Sf1 N0103dSNI CIO 13DVd SIHI S310N NOI103dSNI SVO HOflO l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE PERMIT# (� JOBSITE ADDRESS I J1 n,v-r l(4)S L t i , OWNER'S NAME �,i's t K-t OWNER ADDRESS S I cc 6tb0 VC, TEL S CS"3`I.S- 1 q I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL NI PRLNT CLEARLY 'NEW:Q RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO Q APPLIANCES 7. FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER . s BOOSTER CONVERSION BURNER •. COOK STOVE DIRECT VENT HEATER DRYER • FIREPLACE FRYOLATOR FURNACE GENERATOR I GRILLE INFRARED HEATER • LABORATORY.COCKS 1 MAKEUP AIR UNIT OVEN • • POOL HEATER ROOM 1 SPACE HEATER ' ROOF TOP UNIT I _ 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 ® NO ❑ I IF YOU 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 Massachusetts General Laws,and that my signature on this permit application waives,this requirement. CHECK ONE ONLY: OWNER ❑ AGENT Cl SIGNATURE OF OWNER OR AGENT I hereby certify thatall of the details and information I have submitted or entered regarding this application are true and accurate to the best of knowledge . and that all plumbing work and Installations performed under the permit issued for this application will be in compliance ' all P t vi n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASH I I tR NAME L 's+-€ r !Ala.C&t- LICENSE It 5 fo SI RE MP❑ MGF® JP[Q JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME `""$'E_ce^et TexcLiz.IN•eci c['.-0.4 aa.t s r✓ ADDRESS a3 Boy::c{ '>i vt R CITY oA6t s k. t-e s STATE AAA ZIP lv TEL 5 f}�- i4-71 F51 FAX i1/4.) A CELL 50S-2.50—Ell g EMAIL (1 cc i ?Cs f S. Cyc=v