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HomeMy WebLinkAboutBLDG-21-000551 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE 'August 06,2020 I PERMIT# BLDG-21-000551 JOBSITE ADDRESS 194 OCEAN AVE I OWNER'S NAME IMARZILLI JOHN F J G OWNER ADDRESS MARZILLI KATHERINE 94 OCEAN AVE SOUTH YARMOUTH MA 02664-5724 TEL I ,_ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 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 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 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 at plumbing work and installations performed under the permit issued for this application will be in compliance with at 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 0 JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: ADDRESS. 75 Maureen Rd, CITY Centerville STATE MA ZIP 02632 TEL FAX I j CELL 17742380286 1 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