HomeMy WebLinkAboutBLDG-19-005371 \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
1.
W.. CITY YARMOUTH MA DATE March 26,2019 PERMIT# BLDG-19-005371
JOBSITE ADDRESS 22 OLD SAGA DR OWNER'S NAME MCGONAGLE PHYLLIS A
G OWNER ADDRESS 75 PEARL ST APT 246 READING MA 01867 . . TEL
TYPE
PRINTR OCCUPANCY TYPE COMMERCIAL ❑ /2VI- ,,p. i RESIDENTIAL
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ f PLANS SUBMITTED: YES ❑ NO 0
FIXTURES FLOORS BSM 1 2 3 4 --:5-----` 6 7 8 9 10 11 12 13 14
BOILER 1
BOOSTER
CONVERSION BURNER
COOK STOVE
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 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 0 NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ 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 Richard Whiteside LICENSE# 15850
SIGNATURE
MP 0 MGF 0 JP 0 JGF 0 LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0#
COMPANY NAME: RICHARD J WHITESIDE ADDRESS. 29 MAPLE TER,
CITY SOUTH DENNIS STATE MA ZIP 026603651 TEL
FAX CELL EMAIL
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