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HomeMy WebLinkAboutBLDG-23-002962 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE November 29,202; PERMIT# BLDG-23-002962 JOBSITE ADDRESS 15&17 REINDEER LN OWNERS NAME HEALY KIERAN J G OWNER ADDRESS HEALY JOAN M 118 TRADERS LANE WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 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 1 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Sean Oleary LICENSE# 3957 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0 # PARTNERSHIP ❑# LLC ❑# COMPANY NAME: SEAN F OLEARY ADDRESS. 2 FABYAN RD,2 FABYAN RD CITY Plymouth STATE MA ZIP 023602390 TEL 1 FAX CELL EMAIL advantageheatacna gmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES R . • MILLS-.ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK it ",. � I 1 _- £fT�!'` 4 ){'(i� MP. DATE I(' 9`2("-- a dN PERMIT# 1 OV 2 9 � IT AD RE •SS I ` ��6��k � Cam . OWNER'S NAME i 2 i 1 ! fievky ►L__ a ,ESS TEL - '7- 7-O92 Z?FAX BUILDING DEP _- FRIN,� 1J—OCuU1J.it TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ✓ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES FLOORS-I BSM 1 2 3 11 5 6 7 li 9 10 1111 12 9, 11% BOILER __ BOOSTER CONVERSION BURNER COOK STOVE _ DIRECT VENT HEATER , DRYER _________I _, FIREPLACE — I FRYOLATOR FURNACE / GENERATOR GRILLE INFRARED HEATER. LABORATORY COCKS MAKEUP AIR UNIT OVEN l!l POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST ... UNIT HEATER • UNVENTED ROOM HEATER I WATER HEATER OTHER I . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �O ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ j OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the l 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 rate to the best of m ;nowledge `', and that all plumbing work and installations performed under the permit issued for this application will be in compliance • all Pertinent.pw ' of the Massachusetts State Plumbing Code and Chapter'142 of the General Laws. /.- PLUMBER-GASFITTER NAME LICENSE# 3g57 SIGNAT . MP ❑ MGF❑ JP ❑ JGF ILPGI❑ CORPORATION❑#i PARTNERSHIP❑# LLC❑# COMPANY NAME aVU OF 4/ .GAJC • ADDRESS 9- I17YAGI 12P, CITY Pt Yi'W }� . STATEr� rq ' ZIP c 9./`n�,o /, TEL/553 ! - 7 O6 FAX CELL !1! ( ' /2 (' l / 2 EMAIL /Y`�1 J 6- 17MTrC &6/e✓ . c''- i!II I i I 0 4- I G To n I cr.) I !-- (41 1 Q I 0 W i Lu 4 u, 2- • < o a Ico a. - o a. I- a. till I LL 1 I CO ixa 1 7 �1--H F 0 La o r4 a1 co 2 a cr1 V r= V 0 g 1 I