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HomeMy WebLinkAboutBLDG-21-000246 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK •: CITY YARMOUTHkr, • MA DATE July 16,2020 PERMIT# BLDG-21-000246 JOBSITE ADDRESS 15 HONEYSUCKLE WAY OWNER'S NAME G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO FIXTURES FLOORS--0 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 1 - 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY❑ 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 David Houde LICENSE# 4333 SIGNATURE MP❑ MGF 0 JP 0 JGF 0 LPGI ❑ CORPORATION©# 4333 PARTNERSHIP 0# LLC ❑# COMPANY NAME: McDonnell Mechanical Services,Inc ADDRESS. 79 School St, CITY W Dennis STATE MA ZIP 02670 TEL 5083940005 FAX 5083945050 CELL 5082463152 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes Now THIS APPLICATION SERVES AS THE PERMIT El El �!�� III J1///S/ FEE: $ PERMIT# PLAN REVIEW NOTES