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Home My WebLink AboutBLDG-22-003979 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e CITY YARMOUTH MA DATE January 18,2022 PERMIT# BLDG-22-003979 It - JOBSITE ADDRESS 6 KAREN WAY OWNER'S NAME RONDINA ALAN F G OWNER ADDRESS RONDINA PAMELA S 32 MARGARET DRIVE NORTON MA 02766 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES El NO El 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 1 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 IiabiliN 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 0 OTHER OF INDEMNITY❑ 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 requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that as 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 ISean Oleary LICENSE# 3957 SIGNATURE MP El MGF El JP❑ JGF El LPG! El CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME SEAN F OLEARY ADDRESS, 2 FABYAN RD,2 FABYAN RD CITY Plymouth STATE MA ZIP 023602390 TEL FAX CELL _ EMAIL advantaaeheatac(o,gmail.com S]lON MIAAA]lARI Meld #IIV H d $ :Aad II1Al2:i3d 9H1 SV SAH1S NOi1VOIlddV SIHI oN sa,& S310N NOI103dSNI 1YN1d AlNO 3Sl 210103dSNI 210d 3OVd SIHl S310N NOI103dSNI SVO H9flO 1 Ac .�.T� t�CASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,.�" —Ell-- V-1121116 I.(JO MA DATE /.' 14- s PERMIT# ZZ- `SK7q J ��4 zgz2 70B IT ADDRESS 6 iii' OWNERS NAME ,4j / /aj /(' B ILDI PART By 4 ' d#,A IER ADDRESS - 4 TEL 9S"a"-�-1,3 TY)PTE F OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Er CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: El PLANS SUBMITTED: E . YES❑ NO❑ APPLIANCES T FLOORS-4 RCM BOILER 1 3 1 5 6 7 8 9 10 11 12 IS LLI BOOSTER CONVERSION BURNER COOK STOVE JI DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE lit GENERATOR GRILLE INFRARED HEATED. LABORATORY COCKS MAKEUP AIR UNIT I OVEN _� POOL HEATER l ROOM I SPACE HEATER ROOF TOP UNIT - TEST ' UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER I_� OTHER I- ----I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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. 1 SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT El ' ; I hereby certify that all of the details and information I have submitted or entered regarding this application are tru and accurate to the est of my knowledge `� and that all plumbing work and installations performed under the permit issued for this application will be in corn Fence with re ' nt pr ision of the Nz` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. LU l PLUMBER-GASFITTER NAME LICENSE#3?57 'NA E MP ❑ MGF❑ JP ❑ JGF[r/LPGI ❑ C RPOR.ATION❑# PARTNERSHIP❑i� �y ��nr LLC❑# COMPANY NAME ` l� fro FI 4'c , ADDRESS ) j 4Ifl l20 CITY P }�1D 0 J� STATE M.4 . ZIP 0 a"60 TEL 03 ff'''fk FAX CELL �� d EMAIL U �' i L " NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INS.yECTI,ON NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT ! PLAN REVIEW NOTES