HomeMy WebLinkAboutBLDG-24-752 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY SOUTH YARMOUTH I MA DATE012/03/2024 I PERMIT# BC b G 2L1 - 1 5 ?_
JOBSITE ADDRESS 134 OLD MAIN STREETOWNER'S NAME AUTOMATIC LAUNDRY
OWNER ADDRESS 145 BORDER STREET WEST NEWTON MA 02465 I TEL 617-969-4340 I FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: RENOVATION: REPLACEMENT: ' PLANS SUBMITTED: YES NO
APPLIANCES - 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 6 I
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS `� ` tt
MAKEUP AIR UNIT �
OVEN i
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER '
REPLACING GAS DRYERS IN LAUNDRY
R csM 1�0
INSURANCE COVERAGE
I have a current Iiability_insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES ° NO
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 accupre t 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 . JA9nt prov ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ( �
PLUMBER-GASFITTER NAME[EORGE E THOMPSON LICENSE# 15404 SIGNAT E
MP MGF JP JGF LPG! CORPORATION `# PARTNERSHIP # LLC #
COMPANY NAME:,GEORGE THOMPSON I ADDRESS 52 PRIMROSE LANE J
CITY 'MIDDLEBORO 1 STATE MA 1 ZIP 02346 !TEL 617-828-2337
FAX CELL1617-828-2337 I EMAIL georgeetjrl gmail.com