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Home My WebLink AboutBLDG-22-004416 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK °1' CITY YARMOUTH MA DATE (February 08,2022 I PERMIT# BLDG-22-004416 If- JOBSITE ADDRESS 1151 UNION ST I OWNERS NAME Brianna Romme G OWNER ADDRESS 1151 UNION ST YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT.0 PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 0 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 Matthew Hyland LICENSE# 33776 SIGNATURE MP❑MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION 0#r PARTNERSHIP ❑# LLC❑# COMPANY NAME: MATTHEW HYLAND ADDRESS, 127 COPELAND ST, CITY BROCKTON STATE MA ZIP 023016958 TEL FAX CELL EMAIL hylandhvac(Vgmail.com 1 S310N M3IA3b NVld #IIW2d2d $:33d ❑ ❑ ±I1,1d3d 31-11 SV S3Aa3S NOI1V3IlddV SIH1 oN seA S310N NO1103dSNI 1VNId AlNO 3Sf1 b0103dSNI 2103 39dd SIHI S310N NOI103dSNI SVJ HOflO I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . U.,_,„/C CITY LLAC oJTM Q1L MA DATE 2•7- P3 PERMIT# 2.2- I(0 JOBSITE ADDRESS f sue/ ()Ai c),n „c/T' OWNERS NAME A(41244 0111-'1111& GOWNER ADDRESS TEL SDI'- 2^6.?Sl FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Ig PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:psf PLANS SUBMITTED: YES❑ NO gj APPLIANCES 1 FLOORS 8SM 1 2 3 4 5 6 7 8 9 1 10 11 12 13 14 BOILER BOOSTER CONVERSION BURK ER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER T ROOF TOP UNIT FEB 07 2U2Z TEST UNIT HEATER ( RUILDI-NC Li , UNVENTED ROOM HEATER _ ey _ MEW 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 le NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er 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 ❑ AGENT ❑ 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 a ,/the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance�{l► •yertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTERNAME'N`Ri1KslA t1,1t 4AJ, LICENSE#33776 SIGNATURE MP❑ MGF❑ JP I JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPA NAME I�'{LAAA C , ADDRESS a CJ I Y J �L n CITY AAJMt,PK STATE i't4l� ZIP USG TEL • FAX CELL ]7(1-1-7J /6 EMAIL ci'1i� 11 V4C. 6 1'1L• C°14/1 C COL- I