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HomeMy WebLinkAboutBLDG-18-002882 4` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ! )'�a CITY YARMOUTH MA DATE November 14, ' PERMIT# BLDG-18-002882 xr JOBSITE ADDRESS 2 MILL LN OWNER'S NAME JONES SETH R G OWNER ADDRESS 26 GLEASON ST HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 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 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES El NOD 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 Sean Hanrahan LICENSE# 15822 SIGNATURE MP© MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: SEAN N HANRAHAN ADDRESS 34 N Precinct Rd, CITY Centerville STATE MA ZIP 026322643 TEL FAX CELL EMAIL S31ON M31A32:1 NVld #±IIN?I d $ :33d ❑ ❑1I1A1i3d 3H1 SY SRAS NOUVOIlddV SIHl oN saA 9310N NOIl03dSNI lYNIU AlNO 3Sf1 H01O3dSNI HOd 3OVd SIH1 S310N NO11O3dSNI SV0 HJl0H