HomeMy WebLinkAboutBLDG-23-003698 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
"2.V c CITY YARMOUTH MA DATE January 06,2023 PERMIT# BLDG-23-003698
JOBSITE ADDRESS 36 TOWN BROOK RD OWNER'S NAME ARCHAMBEAU TIKI-JON
G OWNER ADDRESS TAYLOR R&ARCHAMBEAU B 36 TOWN BROOK RD APT A WEST YARMOUTH MA TEL _
02673
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ 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 1
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
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 0 OTHER OF INDEMNITY 0 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 Sean Hanrahan LICENSE# 15822 SIGNATURE
MP 0 MGF 0 JP❑ JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC❑#
COMPANY NAME: Hanrahan Plumbing and Heating ADDRESS. PO box 688,
CITY Centerville STATE MA ZIP 026323217 TEL
FAX CELL 7742380286 EMAIL
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES