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HomeMy WebLinkAboutBLDG-19-004537 A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` k CITY / ,CJft• MA DATE 2// 'q PERMIT#,2P6 M 7 JOESITE ADDRESS Z 25 9 ;iv-e (-20at Lek OWNERS NAME I I M42,11,sv OWNER ADDRESS '�-?2 fr24,di.) S+ 0544i .t/b TEL 774 Zl 2 i32AFAX TYPE OROCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES.1 FLOORS—F BSM 1 2 3 1 5 5 7 13 9 10 11 12 13 1' BOILER I BOOSTER MIM CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE I INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN —� POOL HEATER ROOM 1 SPACE HEATER _ ROOF TOP UNIT x '.- „ ;` TEST . . . .. UNIT HEATER UNVENTED ROOM HEATER ' '_ WATER HEATER E' OTHER1„ _R INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IVIGL.Ch.142 YES [8'NO ❑ I IF YOU CHECKED YES,PLEASE.INDICATE THE TYPE OF COVVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY W 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 ray signature on this permit application naives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ I SIGNATURE OF OWNER OR AGENT j ' -, 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 al ertin ' n of the I Lt Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �-1 PLUMBER-GASFITTER NAME LICENSE# f y`S MP IX MGF❑ JP ❑ JGF❑ LPGI ❑ CORPORATION❑# PAR C.RSHIP❑# LLC❑#l: COMPANY NAME jt 4K ,I+t d.vt i . �1�� c.2 ADDRESS (o2A 44 ANJ (� CITY I " 1 10S4 A)3 0/-1.< I IC STATE /'I A ZIP on. 4 ee TEL 7 2 22 /37I FAX CELL EMAIL TZ & (1 A) /e e0 L.Y-i )_ , I I G1 rg I 1 2 1 I 1 Dr./ I 4, w I I E. 1 I I I I I 1 I I C1'El 7 1 L I w 0 w 0 1 C w -1- st- .. - C) a � 2" CD Q 2 L a. Cl.. < tii. j1%, to (.3).. g / ,.41;C\<. cep I co 0 - , N\11...„.... I I Hall,tee From: Tom Gavin <tcgavinl0@gmail.com> Sent: Thursday, November 21, 2019 9:22 AM To: Hall, Lee Attention! emailores outside©fthe or w n ' + att � 4 ;o cllck links unless you t 1 �,i�ti' ,mn a' y r . rtli t erif are,s�ute t: �e a11�s Qm�a known sender and Diu knew the cc�nte�it��safe; . �y � ncler� ca�u ��1f unsure ©thelse delete this.email,x, ,Y ,r., Hi lee. This is torn Gavin with shark city plumbing. I was asked to reach out to you because of a job on 28 pinewood in yarmouth . I was released of the job and A Dad's plumbing is taking it over for meagher construction. I no longer do any business with them . Thanks any questions let me know. 774 212 1329. 1