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Home My WebLink AboutBLDG-22-006107 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY YARMOUTH MA DATE April 22,2022 PERMIT# BLDG-22-006107 ; JOBSITE ADDRESS 121 CAMP ST UNIT 85 OWNER'S NAME MULCUNRY RICHARD F JR G OWNER ADDRESS MULCUNRY SUSAN A 12 BOXWOOD RD FARMINGTON CT 06032 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: m 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR 1 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 Michael Maloney LICENSE# 11247 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: MICHAEL R MALONEY ADDRESS. 2508 CRANBERRY HWY, CITY WAREHAM STATE MA ZIP 025711003 TEL FAX CELL EMAIL malonevplumbinq(aZcomcastnet 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 ___,._ ... 4 Lt'v .4.. INNFORN APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK :.„--.77-=•_77,4 , V) CITy: d All .1: MA. DATE Vi/9427.2- psimfil 27- 61 0 7 Ames&/d-/ edrh p SAI?if MERU NAME ge herd M is/6 Of)ty G MEI ADDRESS; Vt/;# g'S Ta:4ita0 ric2 g 509.1-FAX: TYPE°R OCCUPANCY TYPE COIRIBICIN.0 EDUCKIIONAL El RESIDENTIAL-6- PRINT CLEARLY NEW:rii— RENOVABOk El REPLACINENT:0 PLANS SU8MIT YES 0 NOle4 •APPLIANDEM FLOOR-. Omni 1 2 3 4 6 8 7 8 9 10 11 12 13 14 BOILER BOOSTER . „ CONVERSION BURNER • . . COOK STOVE _ DIRECT VENT HEATER , ORM . . . PREPUCE FRYOIATOR I ,FURNACE GENERATOR GRLLE %j INFRARED MATER_ It • LABORATORY COCK .- MAKEUP AIR UNIT OVEN .. On 1 POOL HEATER , ROOM/SPACE HEATER _ -sI ROOF TOP UNIT . t TEST I Z -UNIT HavnER .. .IQ INVENTED ROMAJEATER WATER HEATER . . • .. - IOW=CIPERAGE - - I have a currant*bib insurance poky or Issobstrotialapkviateikk masts the aspitanots NIEL M.142 YES&NO 0 If you have checked ZS.please irdcaie the type of aweragebyebeddng the appropriate box below. . mount WSURNICE POUCY fi--- OTIERTYPE INDENNITY 0 BOND El MIER'S INSURANCE WAIVER I an astanteat the km=aainaagett imam caws.requited Wampum'142 alas Massachusetts General Law and that my signals at this pen*appeals.misa Nis requirement. CHECK ONE OILY: OWNER El AGENT 0 •SIGNATURE OF OWNER ORAGENT hereby amity that al ofthe data and Idonagan I bat totalled farmland)was Ws appall=antlme and*carat to the best dm Kw**e and that al pluritte=druid Insatiloos pstfamed adore,pandtbsued fortis applaion NI bah complanceset al Pertinent praAdon of the Massachusetts Slat Patting Code and Chaplet 142 dila Gerald taws. pumERotsFirrER NAME/M(4c1 I I? Mt irilc y UCENSE if 1142 coMw1,Y/wAE rni1i . in G 01 SITRE / C ADORER 09,6oF rO4 he,f_, 1 h a mi cry: W41dM _ STATE i 1 1 if DP: 0 ot51 1 FAX 1EL:56k-05-02y% caLSO Fz5/q-6 va3 BAALeomeirbeict- MASTER040URNEYMANO LP INBTAW3t 0 coRPoRAnoNC14.3V31 ppRom/sHp 0# ILO 0# E i V II 1 L. RAU'SS: