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HomeMy WebLinkAboutBLDG-22-006186 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '_ri CITY YARMOUTH MA DATE (April 27,2022 I PERMIT# BLDG-22-006186 JOBSITE ADDRESS 82 WEBSTER RD OWNER'S NAME (WHITE JAMES T I G OWNER ADDRESS WHITE KATHLEEN B 44 E VILLAGE RD EAST LONGMEADOW MA 01028-1335 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 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 1 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❑ 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 James Papasodero LICENSE# 3782 SIGNATURE MP❑MGF Q JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IARS Boston I ADDRESS. 300,Manley St., CITY (West Bridgewater I STATE MA ZIP 023790001 TEL 5085889025 FAX CELL EMAIL S31ON M31A32I Ndld #IIW213d $ :33d ❑ ❑ 111183d 31A1 SV S3A83S NOIIVDIlddb SIHI oN seA S310N NOI103dSNI 1VNId A1N0 3Sf1210103dSNI 21Od 3OVd SIHI S31ON NOLLO3dSNI SVD HOflO I