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HomeMy WebLinkAboutBLDG-22-003981 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e' CITY YARMOUTH MA DATE January 18,2022 PERMIT# BLDG-22-003981 t; JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 11C OWNER'S NAME Saptarshi Ganquli G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ED PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 'Sean Oleary LICENSE# 13957 I SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: ISEAN F OLEARY ADDRESS. 12 FABYAN RD,2 FABYAN RD CITY 'Plymouth STATE MA ZIP 023602390 TEL ( I FAX I I CELL I I EMAIL Iadvantageheatac(alamail.com S310N M3IA32i NVld #±I1/4J3d $:93d ❑ ❑ lIVOnd 3H1 SV S3A2I3S NOI1VOIlddV SIH1 oN saA S310N NOI103dSNI lVNId AlN0 3Sfl NO103dSNI ZIOd 99Vd SIHI S310N NOI103dSNI SVO HOf1021 SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ... ,0 -CIT ``'1/2k400 UT AI MA DATE /— 1`Y "-42 PERMIIT��# 2Z — 39�/ j‘4407-4 2(220B ITE ADDRESS 5-e✓ i?04-4_i UL�I�!/ O ti�NER'S N,AMEVerf Nir ����F\ B (CC CD EPA WORMER ADDRESS TEL, i 2 A.y� `31 a I + B II-In kirk PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL ge CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:KtV PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS-4 2I 6,.M 13 4 5 6 �, 9 10 'I'I 12 1; 1� BOILER �■ ■ ____, BOOSTER CONVERSION BURNER COOK STOVE { DIRECT DRYER FIREPLACE — FRYOLATOR IIII INFRARED HEATER LABORATORY COCKS • i MAKEUP AIR UNIT GRILLE r--- OVEN ROOM/SPACE HEATER _ 1 ROOF TOP UNIT 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 !1....**140 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ilb OTHER TYPE 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. CHECK ONE 0 LY: OWNER 0 AGENT 0 `-, SIGNATURE OF OWNER OR AGENT ,4- I hereby certify that all of the details and information I have submitted or entered regarding this application are true nd accurate to the b r• of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ance with all Piirte ovision of the _. ' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I.— Lu PLUMBER-GASFITTER NAME LICENSE# 3151 SIG URE MP❑ MGF 0 JP 0 JGF Eff LPGI❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME 4 i4 /- - 4/c Mt, ADDRESS FArkg/ `\Dt CITY )? /'k0O't ft STATE MA= ZIP © v-7 d 6 TEL raC"\ !0"- U FAX CELL EMAIL 4 4( C i. c°'''''` • AOUGII GAS INSPECTION NOTES THIS PAGE FOR.INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ • FEE: $ PERMIT tt PLAN REVIEW NOTES