Loading...
HomeMy WebLinkAboutBLDG-22-006867 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE IMay 26,2022 I PERMIT# BLDG-22-006867 t. JOBSITE ADDRESS 90 NOTTINGHAM DR OWNER'S NAME WHITTEN CRAIG R G OWNER ADDRESS WHITTEN NICOLE L P 0 BOX 1210 SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 11 RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO 0 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 GRILLE 2 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 0 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 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 Wayne Edwards LICENSE# 31581 SIGNATURE MP❑MGF❑JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ADDRESS. 126 Bunting Lane, CITY 'West Yarmouth I STATE MA ZIP 02673 TEL I FAX CELL 7748362534 EMAIL IwavnetheolumberEpmail.com S310N M3IA323 Ndld #liW2i3d $:33d ❑ 111^J213d 3E11 SY SAS NOLLVOIlddV SIH1 oN so), S310N NOI103dSNI 1VNId AlNO 3Sfl H0103dSNI 2i0d 39dd SIH1 S310N NO1103dSNI SVO HJl0H ti Ft. 11_, E> ioACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r,„ o '' Fl 6 2ffi 1eMC u-rN ec R� J�, D.ATE /fy 2-6., 2�J2Z PERMIT# - - (o S�, JOESIT A DRESS �� /�D�Ti,✓G�,¢ I�/Z OWNER'S NAME �!/�c�Ln/ BOI_L IN DEPARTMENT ,/ or __- _OWNER A RESS ' O �`Urr4t/GFl,4.-t PR, TEL 6—(4' 737 171707 FAX TYPE GR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIAL❑ RESIDENTIAL V CLEARLY tJE'JU: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-+ BSlul 1 2 3 1 5 6 7 ° 9 10 11 12 13 BOILER1� BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER _ `—; FIREPLACE t i FRYOLATOR FURNACE GENERATOR GRILLE 0(.r-pops �_� INFRARED HEATER —, i LABORATORY COCKS • --H MAKEUP AIR UNIT OVEN POOL HEATER • I ROOM I SPACE HEATER i ROOF TOP UNIT TEST UNIT HEATER . r _.. .- --- .. _.._ UNVENTED ROOM HEATER • WATER HEATER OTHER I INSURANCE COVERAGE 1 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 INSURANCE POLICY V OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 I Massachusetts General Laws,and that my signature on this permit application waives this requirement. of the CHECK ONE ONLY: OWNER ❑ AGENT ❑SIGNATURE OF OWNER OR AGENT "I 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 ertinent vision ' he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Li} PLUMBER-GASFITTER NAME LICENSE# 3/S21 ATURE MP ❑ MGF❑ JP IE(JGF❑ LPGI ❑ CORPORATION❑## PARTNERSHIP❑#; LLC❑## COMPANY NAME woe-123 / �t ADDRESS 24, B�./T/,✓G 404,,/C CITY IZ/ES'r ylftwteL)r F( STATE ZIP OZ6 73 TEL ?7`:/- 8-36 -25354 FAX CELL 77114-8-3(• 2-S3' EMAIL //JWyr/6 7NEPZ.v,.--(Sekde'6w,efft, Lcd.cq Gj H. 4 r4. rr1 f 4 4 0 in 1 � L_' 1.11 cc �--� ` . . Z .. . EIS . • .. C r Q a_ LLB E-- �-- r t � 1 �1 ► Cb!1 c'J ► 1 �