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Home My WebLink AboutBLDG-22-004514 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE February 14,2022 PERMIT# BLDG-22-004514 JOBSITE ADDRESS 19 CRANBERRY LN OWNER'S NAME TAREK WISSAM R G OWNER ADDRESS 19 CRANBERRY LN SOUTH YARMOUTH MA 02664 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 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 1 OTHER DESCRIPTION:gas piping 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'NSURANCE POLICY ❑ OTHER OF INDEMNITY CI 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 requiremert. 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 Sean Oleary LICENSE# 3957 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATICN❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: SEAN F OLEARY ADDRESS. 2 FABYAN RD,2 FABYAN RD CITY Plymouth STATE MA ZIP 023602390 TEL FAX -I CELL EMAIL advntageheatac(a gmail.com S310N M3IA32i NVId #lIWN3d $:33d ❑ ❑ 111A1213d 3H1 SV S3A213S NOIlVOIlddV SIH1 oN saA S310N NO1103dSNI 1VNId AINO 3Sfl a0103dSNI?JOd 30Vd SIH1 S310N N01103dSNI SVO HOl021 f ` ,,_:.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i I j-p- l/ NtoLitli:'w_11: .w .: iIT'�' E MA DATE �~ -.22_ PERMIT # 'LI — 9 S I c l . -r-c ... 10. C A DR.SS /cr L�' APa�IV /'�- - OWNER'S NAME .-<le- l< FEB 1 r ' OWNER AD RESS TEL � 36t ~4. 'AY TtgEt& VtG DEPARTMENT , ►ECG ions T,FE COMMERCIAL 0 EDUCATIONAL DU�A•i ❑ RESIDENTIAL��SIUENTIAL CLEARLY NEW: Il RENOVATION: ❑ REPLACEMENT: U PLANS SUBMITTED: YES ❑ NO E APPLIANCES FLOORS--I SSM 1 2 3 4 5 6 7 ° 9 10 11 12 13 1 BOILER BOOSTER CONVERSION BURNER COOK STOVE _ DIRECT VENT HEATER DRYER FIREPLACE _Min ! FRYOLATOR FURNACE GENERATOR I GRILLE INFRARED HEATER LABORATORY COCKS I MAKEUP AIR UNIT OVEN i POOL HEATER iI ROOM► ! SPACE HEATER ; ROOF TOP UNIT { , TEST _ _ _ ._. . . ..... .. .. _ _... UNIT HEATER UNVENTED ROOM HEATER I WATER HEATER OTHER & grPE I/ l i . INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IVIGL. Ch. 142 YES NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ri OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the l Massar_husetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT El • 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 nd accurate to thi best of my knowledge `; and that all plumbing work and installations performed under the permit issued for this application will be in comp ance with all P ' nt provision of the Massachusetts State Plumbing Code and Chapter -142 of the General Laws. 4) PLUMBER-GASFITTER NAME LICENSElic ' 'NA RE MP 0 MGF ❑ JP ❑ JGF VLPGI ❑ CORPORATION ❑ li PARTNERSHIP n # LLC ❑ # COMPANY NAME fr\-)06-46F-- IM1 4, ('C rk1L ADDRESS t� ' 404// KO • CITY ��+ c--,SIcet, C�l STATE 4 ZIP 4" J66 TEL � FAX CELL EMAIL Avu c4IC6044/ .r N i I Cf./ 6-4 1 I H C) r4 1 4-1 4. I I I I I 1 I 1 1 w 1 0 w C I Ell 0 F I . LLI . co o > Z. I L 1 Q < I- C7 0. 'al Y I11.1 co � lu! I II 1 i [—I . . y 7 I I, 1 P- 0 L^'' 1 (I.) I 14 I lad h4i cl ci I g