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HomeMy WebLinkAboutBLDG-22-002421 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,� JCITY YARMOUTH MA DATE October 27,2021 PERMIT# BLDG-22-002421 JOBSITE ADDRESS 7 DEBS HILL RD OWNER'S NAME Kathy mcphee G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES ❑ NO❑ 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 1 - _ 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 El 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 Thomas Flynn LICENSE# 34167 SIGNATURE MP 0 MGF ❑ JP© JGF❑ LPG! ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 118 wayside dr, CITY Harwich STATE MA ZIP 02645 TEL 5082413438 FAX CELL EMAIL SSION M3IA32i NVld # $:33d El 11W213d 3H1 SV S3A213S NOLLV011ddV SIHI ON SOA S310N NOI103dSNI 1VNId NINO 3sn 110.1.03dSNI bOd 3OVd SIHI S310N NOI103dSNI SVO HOflO _ r� sa.avh �-- rat,SQACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK —_ a ,EVE 11) . w CTiY �r we a.4.A MA DATE i0a12 D I PERMIT# /r�1 !� iirf 2 f: MITE ADDRESS 7 Pe b'$ M,1f OWNER'S NAME K4-1�y , do I h e BUILGGDEERESS 7 bS I`ll TEL CO' e7/25-02357FAX a _ _ ` — OCCUPTRCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Z] PFtIltii'>i' CLEARLY NEW:Er RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NOR APPLIANCES FLOORS-I BSM 1 2 3 1 5 6 7 s 9 10 11 12 '13 I 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE • DIRECT VENT HEATER DRYER FIREPLACE I FRYOLATOR FURNACE GENERATOR _J GRILLE INFRARED HEATER - - i LABORATORY COCKS • MAKEUP AIR UNIT OVEN POOL HEATER • ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER 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 g NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY RI OTHER TYPE INDEMNITY ❑ 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. CHECK ONE ONLY: OWNER ❑ AGENT El 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 Nzs Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE#3 two? AATURE MP ❑ MGF❑ JP 0 JGF❑ lLLPGI Li CORPORATION❑# PARTNERSHIP❑# LLCr❑#/(COMPANY NAME hY#5 r-Ac wilt) ADDRESS / 9 i So' 1 (ASV, v d, CITY CQ-rS 1'1 c A1f,Z1S STATE/1 4 ZIP 0,26 yg TEL s--oe ),-06 FAX CELL EMAIL /C m/4/.5�l v.z'60.5 A r7 .CdG! ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTE Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT( PLAN REVIEW NOTES • • • r,