Loading...
HomeMy WebLinkAboutBLDG-22-002295 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ma CITY YARMOUTH MA DATE October 21,2021 PERMIT# BLDG-22-002295 t! e JOBSITE ADDRESS 112 WEDGEMERE RD _ I OWNERS NAME TOMASO ARLENE BYRON(LIFE EST' G OWNER ADDRESS TOMASO KENNETH 57 NATURE VIEW DR UXBRIDGE MA 01569 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 i 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 POOL HEATER _ ROOM'SPACE HEATER ROOF TOP UNIT -TEST UNIT HEATER • UNVENTED ROOM HEATER WATER HEATER 1 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 El BOND ❑ OWNERS 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 as 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 'Spencer Hallett I LICENSE# 16224 SIGNATURE MP©MGF❑JP❑ JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: 'SPENCER HALLETT I ADDRESS. 1381 Old Falmouth Rd Unit 36, I CITY IMARSTONS MLS I STATE MA ZIP 026481372 TEL I I FAX I I CELL I I EMAIL Ispencer(o.hallettplumbinp.com I S31ON Ndld #IR N ld $ :33d ❑ ❑ 1IWH d 3HI Sd S3A2f3S NOI1V011ddd SIHL oN sa,, S310N NO1103dSNI'MU AlNO 3Sfl 8010DdSNI 210d 3Jdd SIHL S310N N01103dSNI SVO HJfOH MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =Afar iy CITY mpv4 1 I MA DATE .1710-1 i 0-2-1 I PERMIT # V-- Z .� JOBSITE ADDRESS W_„W eC,_1e.y1_e IIQ CS OWNER'S NAME [w t? ^4i14 C4oi^ OWNER ADDRESS [Sc4,rr ,... . TEL 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL E PRINT CLEARLY NEW: RENOVATION: I REPLACEMENT: 17i PLANS SUBMITTED: YES Ei NO APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ,.,_ _ j ... . . R. ,�.r...:�::.� �..__.. �...._. �._ - BOOSTER CONVERSION BURNER COOK STOVE J • s -,._ az ._. -I,. . __.... DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR I FURNACE I GENERATOR GRILLE " INFRARED HEATER _J-- LABORATORY COCKS .,_,_. MAKEUP AIR UNIT OVEN POOL HEATER ' ROOM / SPACE HEATER ROOF TOP UNIT 1.. .. .._ ; _ - , n ..._.,..yLr ._. _. ._. ._._ 1 TEST 1 - 1. UNIT HEATER UNVENTED ROOM HEATER WATER HEATER ( . I _. OTHER 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [ NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [71 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 [J AGENT 1.._., 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 - -• accurate - •est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com. . • - 1'ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Spencer Hallett I LICENSE # 16224 SIGNATURE MP Ld MGF JP 0 JGF 0 LPGI 71 CORPORATION 0# 3834 PARTNERSHIP # r LLC ( # COMPANY NAME: Spencer Hallett Plumbing & Heating, Inc, I ADDRESS 381 Old Falmouth rd, Suite 36 CITY Marstons Mills I STATE MA ZIP 02648 ITEL 508-428-6080 I FAX`508-428-7991 I CELL ,EMAIL sue@hallettplumbing.com Ctc t c(f; 1 Uk