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Home My WebLink AboutBLDG-23-001598 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0 Lir CITY 'YARMOUTH I MA DATE September 27,202 PERMIT# BLDG-23-001598 JOBSITE ADDRESS 108 WILFIN RD OWNER'S NAME IMichelyn LLC I G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El 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 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE _ GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 El OTHER OF INDEMNITY El 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 Robed Venable LICENSE# 10401 SIGNATURE MP 0 MGF 0 JP El JGF 0 LPG! El CORPORATION 0# PARTNERSHIP ❑H LLC❑# COMPANY NAME 'ROBERT L VENABLE I ADDRESS. 6 JUDSON ST, CITY IWAREHAM I STATE MA ZIP 025712776 TEL FAX CELL EMAIL Ikmvenable1961(o,pmail.com I - , S31ON M3IA32:1 NVId #1IWb3d $:33 ❑ 0 11110nd 3H1 SY S3/1213S NOI1V3Ildd`d SIHI oN seA S310N N01103dSNI 1VNId AlNO 3Sf H0103dSNl 210d 30Vd SIHI S3ION N01103dSNI SYS HDflO J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,t om CITY 5n / U/ Y .xri-( MA DATE PERMIT 4 Z 3 11 5g JOBSITE ADDRESS U O UV 12_d OWNER'S NAME OWNER ADDRESS 34 kt.A.ActJ TEL FAY TYPE OR OCCUPANCY \ftNt_S r G2t0 C�J PRINT �Y TYPE COMMERCIAL ElEDUCATI ION,AL ❑ RESIDENTIAL g, CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ F 1-4RSEJ IT EL�' VEIJv❑ APPLIANCES 4 FLOORS-+ BSM 1 6 7 ° � Ii 14 2 3 4 5 9 1 11 1 I; BOILER BOOSTER CONVERSION BURNER, BUILDING UtF'kK►MENT �— COOK STOVE _ DIRECT VENT HEATER DRYER FIREPLACE / FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN - I POOL HEATER • ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSU CE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ • OWNER'S I NCE W VER: ware that t icensee does not have the insurance coverage required by Chapter 142 of the Massac s_ e1 r a s, n tat my si lure on this permit application waives this requirement. ff/ /.v z- c- CHECK ONE ONLY: OWNER tSi AGENT ❑ IGN U OF OWNER OR AGENT ereby certify that all e details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge `1.- and that all plumbing work and installations performed under the permit issued for this application will be in corn Hance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `�l�� PLUI�R6ER-GASFIT'fEP,NAME /�ob.Qf/ Z• 1/e.,cblc LICENSE# ��Zul 51 ATURE MP M, MGF❑ JP ❑ JGF❑ LPGI El CORPORATION El# PARTNERSHIP❑# LLC❑# COMPANY NAME ADDRESS 6 jL.LC(SON CITY (f`e_ka ytA_ STATE ZIP 0 LC `7 1 TEL FAX CELL 5- g 003 7 EMAIL 1 0t f tiVIAAC-&19 0I c9McLti "al ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS TI IE PERMIT , (l FEE: v PERVT # PLAN REVIEW NOTES