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HomeMy WebLinkAboutBLDG-22-002033 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7:=1°1=6 k CITY YARMOUTH MA DATE October 08,2021 PERMIT# BLDG-22-002033 JOBSITE ADDRESS 50 Center St OWNER'S NAME MARK KELLEY G OWNER ADDRESS 1500 MARY DUNN ROAD BARNSTABLE MA 02630 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ID PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER 1 FIREPLACE 1 FRYOLATOR FURNACE • GENERATOR GRILLE , INFRARED HEATER , LABORATORY COCKS MAKEUP AIR UNIT OVEN • POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 El 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 Eric Whiteley LICENSE# 15920 SIGNATURE MP El MGF 0 JP 0 JGF 0 LPG] 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: W Vernon Whiteley ADDRESS. PO Box 1266, CITY West Chathan STATE MA ZIP 02669 TEL 5089451100 FAX CELL EMAIL S310N M31A32! Ndld #.IW2i3d $ -33d El El lJIAJ d 3H1 SV S3Ab3S NOLLVOIlddV SIHI oN saA S31ON N01133dSNI 1VNId AlNO 3Sfl H0103dsNl Hod 3DVd SIH1 S31ON N01103dSNI SVO HJl0H