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HomeMy WebLinkAboutBLDG-23-004038 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `74-14*) CITY YARMOUTH MA DATE January 23,2023 PERMIT# BLDG-23-004038 ,. JOBSITE ADDRESS 1 DARTMOOR WAY OWNERS NAME RENO LEONARD R JR G OWNER ADDRESS RENO CATHERINE L 1 DARTMOOR WAY YARMOUTH PORT MA 02675-0337 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 , FIREPLACE . FRYOLATOR FURNACE , GENERATOR 1 , GRILLE INFRARED HEATER LABORATORY COCKS , MAKEUP AIR UNIT OVEN POOL HEATER , ROOM I 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 ❑ 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 T 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 John Quinlan LICENSE# 11932 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG] 0 CORPORATION 0#I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: JOHN W QUINLAN ADDRESS. 118 ELM ST, CITY IE BRIDGEWTR I STATE IMA I ZIP 1023331418 I TEL FAX I I CELL I I EMAIL Iinsbections(a.cottiiohnson.com I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No U� Z I I of'Z 3 c FS THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k,, = , v f 3l Z3— G/v3S _` ) CITY 1 Cif`MO CJ MA DATE 1 a PERMIT# JOBSITE ADDRESS \ OCCc'-YY1DC7c C(...Cul OWNER'S NAME Len�'C��h-e,rinE', CZPnc� GOWNER ADDRESS I TEL ",%q-61'R 5 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[ PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO EV- 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 1 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 liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES E. NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [11-."' 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 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. Vrt/ C PLUMBER-GASFITTER NAME John Quinlan LICENSE#11932 SIGNATURE MP 07 MGF❑ JP❑ JGF❑ LPGI ❑ CORPORATION [ # PARTNERSHIP❑# LLC❑# COMPANY NAME Cotti Johnson ADDRESS 30 Waverly st CITY Taunton STATE MA ZIP 02780 TEL 774-501-3041 FAX CELL 774-226-3403 EMAIL Jquinlan@cottijohnson.com