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HomeMy WebLinkAboutBLDG-17-002280 #720 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK :I� y iq ,0�} CITY YARMOUTH MA DATE October 31, 201I PERMIT# BLDG-17-002280 JOBSITE ADDRESS 714 ROUTE 6A OWNER'S NAME OLOUGHLIN JOSEPH V TRS G OWNER ADDRESS OLOUGHLIN ALMA C TRS 2 HAROLD ST HARWICHPORT MA TEL 02646-1517 1'y'PL OR OCCUPANCY TYPE COMMERCIAL J❑ 7.20 RESIDENTIAL ❑ PRINT CLEARLY NEW ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YESD 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 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 © NOD 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 Andrew Levesque LICENSE# 15162 SIGNATURE MP© MGF❑ JP❑ JGFD LPGID CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ANDREW M LEVESQUE ADDRESS 461 LOWER COUNTY RD, CITY HARWICH PORT STATE MA ZIP 026461831 TEL FAX CELL EMAIL • S31ON M3In32:1 NV1d #IIW2i3d $ 33d Dill/W:13d aHl SV SDAHi3S N011d3llddd SIHl oN saA S310N NOI103dSNI 1`dNk A1NO 3Sn H01J3dSNI 2:1Od 3OVd SIHI S31ON NOI1O3dSNI SVD HOnoH MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY Yarmouth MA DATE 10/25/16 PERMIT# eikVjj--/7 400 JOBSITE ADDRESS 720 A / 722 A Route.22 '- OWNER'S NAME O'Loughlin GOWNER ADDRESS Yarmouth Port TEL 508-362-4942 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑x EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑X REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO APPLIANCES 7 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 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES EYNO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' OTHER TYPE 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 Andrew Levesque LICENSE# PL15162 �� GNATU " �� MP' MGF' JP Cl JGF El LPG!❑ CORPORATION❑# PARTNERSHIP❑# LLC gilt 3944 COMPANY NAME Harwich Port Heating & Cooling LLC ADDRESS 461 Lower County Rd CITY Harwich Port STATE MA ZIP 02646 TEL 508-432-3959 FAX 508-432-6075 CELL 508-958-4874 EMAIL andy@hphcinc.com a