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HomeMy WebLinkAboutBLDG-22-005031 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �1 CITY YARMOUTH MA DATE March 10,2022 PERMIT# BLDG 22 005031 JOBSITE ADDRESS 9 PHEASANT COVE CIR OWNERS NAME MCCABE JOHN H G OWNER ADDRESS MCCABE LESLIE R 130 COOLIDGE RD WORCESTER MA 01602 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES © 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 1 , 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 0 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 peter jones LICENSE# 13577 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: peter tones p&h ADDRESS. 6 chickadee In, CITY (west Yarmouth STATE MA ZIP 02673 TEL 5082375207 FAX CELL EMAIL S31ON M31A32I NVId #111(213d $ 33d ❑ ❑ .IV 3d 3Hl SV S]ATJ3S NOI1VOIIddV SIHl oN saA S310N NO1103dSNI IVNId AINO 3Sfl 210103dSNI 21Od 3OVd SIR! S3 LON NO1103dSNI SVO H0l021