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HomeMy WebLinkAboutBLDG-22-005722 — MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK +;" s CIT> YARMOUTH -1 MA DATE April 06,2022 PERMIT# BLDG-22-005722 11 < JOBSITE ADDRESS 24 CHEYENNE LN OWNER'S NAME OLOUGHLIN JOSEPH P G OWNER ADDRESS OLOUGHLIN JONALOU 24 CHEYENNE LANE YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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❑ 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 sigiature 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 Gary Jones LICENSE# 8890 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Gc Jones Plumbing&Heating ADDRESS. 12 Yeoman dr, CITY West Yarmouth STATE MA ZIP 02673 TEL 5085092725 FAX —1 CELL EMAIL S310N M31A3b NVId #1I01213d $:33d ❑ ❑ 111NN3d 3H1 SV S3A$3S NOI1VOIlddV SI1-11 oN soA S31ON NO1103dSNI 1VNId AlNO 3Sfl 210133dSNI?d0A 30Vd SIHI S310N NO1133dSNI SVO H0f1021