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HomeMy WebLinkAboutBLDG-22-001201 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ~I CITY YARMOUTHft MA DATE September 01,202 PERMIT# BLDG-22-001201 li JOBSITE ADDRESS 8 MAYO RD OWNERS NAME Brian Kearny G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ ROOF TOP UNIT _ TEST 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Michael Teebagy LICENSE# 11643 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL F TEEBAGY ADDRESS. 9 SURREY DR, CITY CARVER STATE MA ZIP 023301122 TEL FAX CELL EMAIL topbostonplumber(a,pmail.com S3ION M31A321 Ndld #11M:13d $ :33d El El 1IV Hd 3H1 SV S3A213S NOIlV011ddV SIHI oN saA S310N NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 210d 3OVd SIH. S3ION NO1103dSNI SVO Fiona!I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ka- r, —_r `, CITY: /4iZfT7(JC Jl MA. DATE 4 LYs 2421 PERMIT# JOBSITE ADDRESS: Y17C) pc� i OWNER'S NAME:? z i��, h �►tib / G OWNER ADDRESS: / TEL'I P-a-ZA'L 2 AX: / TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 F J APPLIANCES-1 FLOOR-. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ _ 7 BOOSTER O CONVERSION BURNER ✓ COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE (0 FRYOLATOR t '� FURNACE I I _ GENERATOR _ GRILLE lv INFRARED HEATER LABORATORY COCKNJ _ _ _ MAKEUP AIR UNIT ' OVEN POOL HEATER ROOM/SPACE HEATER • -.J ROOF TOP UNIT TEST f Z UNIT HEATER i,u UNVENTED ROOM HEATER WATER HEATER 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 have checked YES,please indicate the type of coveragpby checking the appropriate box below. LIABILITY INSURANCE POLICY, OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee des 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. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to a st of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be In compile all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: M lC:l-tf E!, /ECI qG; LICENSE#M I i lj,y'. RE. COMPANY NAME: NA14:-\:"* - `/4fC: ADDRESS: 9 >2►2 t �2%t✓G CITY: .A(c-v STATE: �/A ZIP: UZ -3C FAX: `"�- TEL: CELL:I��) 7"'&e 6)/ EMAIL'.TO PL`�SToi.-li'w 0/2. (,/MIL-Cc MASTER JOURNEYMAN❑ LP INSTALLER 0 CORPORATION 0# PARTNERSHIP El# LLC El# C`ri4-/L ADDrZE ss : 7 fl oSIC' f L(jA41-e_ 4pg7 9/6 , CCi-1'7 � s i 1