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Home My WebLink AboutBLDG-22-005626 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK j CITY YARMOUTH MA DATE April 04,2022 PERMIT# BLDG-22-005626 JOBSITE ADDRESS 243 WOOD RD OWNER'S NAME Mary O'Reilly G OWNER ADDRESS 243 WOOD RD SOUTH YARMOUTH MA 02664-4253 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El FIXTURES FLOORS--I 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 1 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❑ BOND El 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 Brendan O'Reilly LICENSE# 30679 SIGNATURE MP❑ MGF ❑ JP❑ JGF El LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: BRENDAN M O'REILLY ADDRESS. 23 PINE ACRES RD, CITY IFOXBORO I STATE MA ZIP 020351315 TEL I FAX I I CELL I I EMAIL Ibmo485(@Nahoo.com J S31ON M31A3a NVId #.IWa3d $:33A ❑ ❑ lWW213d 3H1 SV S3A213S NOIaVOIlddV SIHl oN saA S31ON N01103dSNI 1VNId ,LINO 3Sfl d0103dSNI aOd 3OVd SIH1 S310N NO1103dSNI SVO H`JflOa `4‘. ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R_�l i,_` ° V E D '1 22- (,zL ? CITiG- r r"NU �' MA. DATE: 1 "� C 2 PERMIT# 5 AP' 0 4 2B2BDDRESS: 1 /3 C.Ircrc,t? rck OWNER'S NAME: 1 r c-M/ Q Ac'f y i_ Bit„,--_-biaE,_,,,,,,. DRESS: J `13 L, cc!c�_ (-4 TEL: S 626: ?","'1 I FAX: v ---- OCCiBoa tY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL[Er- PRINT / CLEARLY NEW:[s RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 APPLIANCEST FLOOR Bsmt 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 Fe ✓ ' FRYOLATOR FURNACE GENERATOR _ y' GRILLE VI INFRARED HEATER w LABORATORY COCK kMAKEUP AIR UNIT q OVEN POOL HEATER ROOM/SPACE HEATER J ROOF TOP UNIT _ 'j TEST :2 UNIT HEATER _ , 1.1.1 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 0 NO Er- If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 OTHER TYPE 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 y signature on this permit application waives this requirement. Rao, L1 F- 'LL CHECK ONE ONLY: OWNER (AGENT 0 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 I compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ --r G PLUMBER/GASFITTER NAME: r-'c t^(C' O 1c- 1)/ LICENSE# 0175 SIGTIATURE COMPANY NAME: Vg a'- V -.. �Y ADDRESS: 2 3 e �`_ )9c'J i CITY: t -%><'ti c, '` STATE: n"'P ZIP: 0;?03s FAX: TEL: Sc.),)"-b'/3 "5-(0("7 CELL: EMAIL: bw.c `, 1 S y kvid c L. MASTER❑ JOURNEYMAN ErLIINSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC 0# c 117 rlic. ADD,2c-.5S : . • $aftSOC C 319A I• sir.yc• ai try„ s i wJ;i F]°N3tt Y:fY�y,r j rrs , l 5,3V'a`ir kh?ict Iti '•'riA:Sn't7eT5Ytt;1 = stlYslo • _ .. _t. .. .._._-- • A I;A3 t J -'. H yAF2A1 tt J . . pr • ...•. iri,p%'LnfC u{V`19 B11�tVE11GQ 1: • ,. 4.6 :if'nc..5 :.S.j icisna7 ett•r yt ectilvi