The URL can be used to link to this page

Home My WebLink AboutBLDG-22-002259 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK lc CITY YARMOUTH MA DATE October 19,2021 PERMIT# BLDG-22-002259 JOBSITE ADDRESS 70 GREENLAND CIR OWNER'S NAME Mario Ranalli G OWNER ADDRESS 70 GREENLAND CIR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0 FIXTURES FLOORS-0 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 L 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 0 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 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 jeff normandy LICENSE# 16750 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG' ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. P.O.BOX 923, CITY brewster STATE MA ZIP 02631 TEL FAX CELL EMAIL inonnandvhvacta7.pmail,com S3LON MIA NVId #iIWH3d $ 33d ❑ ❑ 1IWH3d 3H1 SV S3AH3S NOI1VOIlddV SIHI oN SaA SR ON NO1103dSNI IVNId AINO 3Sf1210103dSNI HOd 30Vd SIHI S31ON NO1133dSNI SYS H0f10H MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • it_ CITY: 1 c,t r,n.P—•QV\ MA. DATE I vI I v PERMIT# JOBSITE ADDRESS +C) ��"1 IA✓1 d CA,t c('e OWNER'S NAME: VV'AT 10 W ,111 I I GOWNER ADDRESS: TEL: 5t ('J FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL D EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:17f PLANS SUBMI I fED: YES❑ NOS APPLIANCES1 FLOOR-0 Bsmt 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 kA INFRARED HEATER w LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER -J ROOF TOP UNIT fi TEST UNIT HEATER +U UNVENTED ROOM HEATER WATER HEATER ✓ ` INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES t NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY El 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 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 core Hance with all Pgrtinnent provision of the Massachusetts State.Pllumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTERNAME: ..)4(.. 1• +1M1 -. LICENSE#/61 -644 _ IGNATURE COMPANY NAME: Ni \ I CI ADDRESS: -� CITY: /--•>( � +�✓17r-T ./' STATE: /I✓I 7 G _—;2� ZIP: I `- FAX Ca? " C/,� TEL: CELL: C Z 3 -;1" `T (NAIL: MASTER JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# c /c ADD2c ss : _ • r-r c_% I .