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HomeMy WebLinkAboutBLDG-22-002384 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK BLDG 22-002384 e CITY YARMOUTH MA DATE October 26,2021 PERMIT# kr_,t_i_ JOBSITE ADDRESS 7 LIEFS LN OWNER'S NAME ODONNELL WILLIAM J JR TRS G OWNER ADDRESS ODONNELL JANE C 7 LEIFS LANE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 � � -- — — . BOOSTER - CONVERSION BURNER • COOK STOVE 1 _ _ _ 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 r 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 Eric Whiteley LICENSE# 15920 SIGNATURE MP 0 MGF © JP❑ JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: W Vernon Whiteley ADDRESS. PO Box 1266, CITY W Chatham STATE MA ZIP 02669 TEL 5089451100 FAX CELL EMAIL S310N M3IAal NVld #IIINH3d $ 33d JJV d 31-11 SV S3A 3S NOLLVOIlddV SIHl oN saA S31ON NOI133dSNI"1VNId AINO 3Sfl 21O1O9dSNI 210d 30Vd SIH1 S31ON N01103dSNI SVO HJflOH