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Home My WebLink AboutBLDG-21-004461 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' , =j; CITY YARMOUTH MA DATE February 05,2021 PERMIT# BLDG-21-004461 JOBSITE ADDRESS 171 LONG POND DR OWNER'S NAME LONG LEONARD T G OWNER ADDRESS 147 SUNSET STRIP MASHPEE MA 02649 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO ❑ FIXTURES FLOORS—0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 Matthew Hyland LICENSE# 33776 SIGNATURE MP 0 MGF ❑ JP❑ JGF 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MATTHEW HYLAND ADDRESS. 127 COPELAND ST, CITY BROCKTON STATE MA ZIP 023016958 TEL FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES c,- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK s =c. .Xl ✓a j Z 1 `t 6/ CITY ✓TLA M,,Mo✓i 4{ MA DATE A r2I' / PERMIT# JOBSITE ADDRESS /7/ (o.) �.0 lAIA-7 OWNER'S NAME‘gc`, Pere,/irpr GOWNER ADDRESS TEL }UFO" 0q-7g?( FAX TYP E OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[g CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: KJ PLANS SUBMITTED: YES❑ NO Pt] 1 APPLIANCES 1 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 E !s E. E D POOL HEATER F. _--- ..• ------------1 ROOM 1 SPACE HEATER T 1 ROOF TOP UNIT _ 1 rh tt3 1) 1 321 TEST UNIT HEATER BU14DING DEI'ARTIMiE71T UNVENTED ROOM HEATER FEY - - ---------- 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 re 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 ac at the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance I ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTEF NAME i K(W \k1t-A0 LICENSE#317767 SIGNATURE c MP❑ MGF❑ JF' [/ JGF❑ LPGI ❑ CORPORATION ❑# PARTNERSHIP❑# LLC❑# �f r COMPA Y NAME '(i.,ArtA \\,U IC , ADDRESS ,S a C9/e J-?/L• CITY KAA.) 0(.PN, STATE b I�'//1 ZIP �36 TEL , FAX CELL 177' 0-7(9-b EMAIL l"'YL1N11 V4 IL• CO .n.