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Home My WebLink AboutBLDG-22-004414 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK F. CITY [YARMOUTH MA DATE February 08,2022 PERMIT# BLDG-22-004414 JOBSITE ADDRESS 143 HIGGINS CROWELL RD OWNER'S NAME MAGUIRE JANET M G OWNER ADDRESS 143 HIGGINS CROWELL ROAD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO ❑ FIXTURES FLOORS 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 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 El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY CI 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 I hereby certify that all Cf 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-GASFITTE'R NAME 'Matthew Hyland _LICENSE# 33776 SIGNATURE MP El MGF El JP El JGF❑ LPG' El CORPORATICN❑# PARTNERSHIP El# LLC ❑# COMPANY NAME MATTHEW HYLAND ADDRESS. 127 COPELAND ST, CITY 'BROCKTON STATE MA ZIP 023016958 TEL FAX ( CELL EMAIL hvlandhvaca(�.gmail.com S310N M31A311 NVld #LIW2i3d $:33d ❑ ❑ 111183d 3H1 SY S3/Q13S NOI1V011ddtl SIH1 oN saA S310N N01133dSNI 1VNld AINO 3Sfl a0103dSNI 210d 3OVd SIHI S310N N01133dSNI Sb0 HOl0N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . CITY Q,S l�2 HMO j l\-4 MA DATE a- 7- a PERMIT# IA— 1 1`7 c` JOBSITE ADDRESS 14 '155l $ CCouJQ. .\ �� OWNERS NAME LA)CC 't,$LCG (LQ OWNER ADDRESS TEL 5 6e'77Y"��c2 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[S PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO i] APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I _ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER _ I RECEIVED ROOM/SPACE HEATER ROOF TOP UNIT TEST f EB 07 262Z UNIT HEATER UNVENTED ROOM HEATER BUILDING Utl'ARTMENT WATER HEATER uy - - — OTHER INSURANCE COVERAGE I have a current liabil _,,insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Eli NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2:1/ 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a%mat i.the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance 'ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME 1'�NC(Krfn1 k/iL�4v, LICENSE#31776 SIGNATURE MP❑ MGF❑ JP[ JGF❑ LPG!❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPA Y NAME/A4 LArtA `It\C , ADDRESS el C.9/� -e2• CITY (ANtnc.P4{ STATE i i1 ZIP OV62 TEL • FAX CELL 77(I'6)1-7(46 EMAIL kY(,IN.h 14 PC, 611141C. C°wl C � lDc cv,