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HomeMy WebLinkAboutBLDG-23-004407 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` 'a' CITY YARMOUTH MA DATE February 09,2023 PERMIT# BLDG-23-004407 "-- JOBSITE ADDRESS 71 ARROWHEAD DR OWNER'S NAME Thomas Young G OWNER ADDRESS 71 ARROWHEAD DR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 DIRECT VENT HEATER DRYER 1 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 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Halloran LICENSE# 10984 SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: JOSEPH M HALLORAN ADDRESS. 29 Forest Glen Rd, CITY Hyannis STATE [MA ZIP 026012537 TEL FAX CELL EMAIL sowdawgWcomcast.net S310N M3IAal NVld #1R'N J d $ :333 ❑ ❑ if N d 3Hl SV S3I1b3S NOLLVO lddV SIHI `-4 Z (,I f - ON se), S31ON N01103dSNI 1VNId KING 3Sl 210103dSNl 2j0d 39Vd SIHI S310N NO1103dSNI St10 HOflOH i 6---,...._ SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK C1VFD CITY_ G MA DATE `� Z PERMIT } `! `'I ) 1 2-_EB �� A DR_SS 71 4,,Areivhi.4-U of<4 viZ. OWNER'S NAME 7 7a•^71 s e%C-14,---5 Bt 7NG OECO( WF AIDR SS TEL FAX ey _ 1 . PRINT 0 , YPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q' CLEARLY NEW:fiti RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-t BEIM 1 ? 3 4 5 6 7 8 9 10 11 12 19 14 1 BOILER ' BOOSTER CONVERSION BURNER COOK STOVE ❑ DIRECT VENT HEATER DRYER .' —____, FIREPLACE —� FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATERI I =i LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ���� �-1 ROOF TOP UNIT TEST - J UNIT HEATER UNVENTED ROOM HEATERI . WATER HEATER __MIIIII --r OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IUIGL.Ch.142 YES FIND .J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E BOND ❑ OUVNER'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 rrly signature on this permit application waives this requirement. ,i CHECK ONE ONLY: OWNER ❑ AGENT •-, SIGNATURE OF OWNER OR AGENT 7 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and etc rate to t `� y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compce i all Perti t J ion of the �' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Li j PLUMBER-GASFITTER NAME LICENSE#/c 71ci 1 CI `NATURE MP MGF❑ �JP ❑ JGF gri LPGI ❑ CORPOP TION ❑ t PAR NERSHIP❑# LLC❑1. COMPANY' NAME- .1�'s�' c� �� �/ //ci�'��- ��j ..c, ADDRESS `/ FC42 / S f G/.,/.„ CITY H ,yn'A,i S / STATE .//),1 ZIP C%7- 6 a / TEL5C '13'6-3- 2Cy 3 ', FAX CELL EMAIL Sc't-tiC11.'4 w oL 6) co,y c,�S t, ,v 7' .�J � I Eb 0 4 z 0 I E„ I u La at c.".) 4 I I 0 4 G "'D • cm] -- to cr., CE Ew 1.1.1 C = F w L . q 1" � 1 w Cl) a O o A, A, a . rg t. 1 a.. Cl) I LU LL I I C) 4p� V ww-- pd Iv\ NI 0 j 0 I b i