HomeMy WebLinkAboutBLDG-25-481 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY West Yarmouth MA DATE 09/08/2025 PERMIT#i�' 2 S f.
JOBSITE ADDRESS 9 Theodore Roosevelt Rd OWNER'S NAME Bernie McDonald
GOWNER ADDRESS Same as Above TEL 781-858-5728 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER I 1
BOOSTER
CONVERSION BURNER
COOK STOVE 1
DIRECT VENT HEATER
DRYER 1
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
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES :N010
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW SFP 0 9 2025
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BONDI
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage require WAapter 142 of the
Massac etts Gene I L that 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 comp with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Shane Wise LICENSE#25556 SIGNATURE
MP MGF JP - JGF LPGI CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME:Wise Plumbing ADDRESS 7 Christopher Rd
CITY Waltham STATE MA ZIP 02451 TEL 617-347-8000
FAX CELL EMAIL spw@rwsullivan.com
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