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HomeMy WebLinkAboutBLDG-23-005627 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�` 6 CITY YARMOUTH MA DATE April10,2023 PERMIT# BLDG-23-005627 ma=`)t `. JOBSITE ADDRESS 79 ELDRIDGE RD OWNER'S NAME COUTURE ELAINE M TR G OWNER ADDRESS 11 SEAVIEW DR KINGSTON 02364-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 111 PRINT CLEARLY NEW: El 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 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 ❑ NO El 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 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 Robert Heaney LICENSE# 32219 SIGNATURE MP❑ MGF ❑ JP© JGF El LPGI El CORPORATION El# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ROBERT L HEANEY ADDRESS. 33 RICHARD DR, CITY HANOVER STATE MA ZIP 023392537 TEL FAX CELL EMAIL rheaney1(@.vahoo.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES =__ I V !AppACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK O ++ D AMA. DATE: ERMIT# ITE ADDRESS: r JC� ',.Q ^CT OWNER'S NAME f cx-,` C'1 1 r`e U 3uiL6DEA px6 0RES5: I i 5 ut1/4-0- C)r r`� ' EL: FAX: 1 YYL O}C OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL] PRINT U CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT;, PLANS SUBMITTED: YES 0 NO jj APPLIANCESZ FLOOR-+ Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER U COOK STOVE DIRECT VENT HEATER �-- DRYER FIREPLACE UFRYOLATOR FURNACE j GENERATOR GRILLE VI INFRARED HEATER W LABORATORY COCK kMAKEUP AIR UNIT rJ OVEN POOL HEATER ROOM I SPACE HEATER �) ROOF TOP UNIT TEST :Z UNIT HEATER 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 ❑ NO If you have 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. �s J��` CHECK ONE ONLY: OWNER,tQ AGENT 0 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 appli on willjoe in mpllance wtth,all Pertinent provision of the Massachusetts S te.Plumbing Code and.CChapter 142 of the General Laws. ,;- `1 }j • PLUMBER/GASFITTER E: t l L 1/-�C'_ LICENSE# � 6,1 �-S'IG AL `� NATURE -�)l-t-°1-7 COMPANY NAME: CID( r -eO 33O ADDRESS: I C `rc)^ r CITY: f I ITC V-` STATE: in ZIP: a Of FAX: TEL: CELL: 7�D I 7 ) � / 0 )o'EMAIL: "RA/ 1 f u4cr& MASTER❑ JOURNEYMAN tj LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# c h'i i}r[.. 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