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HomeMy WebLinkAboutBLDG-19-000645 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .,ulA€ � CITY Yarmouth Port MA DATE 07/31/2018 PERMIT#�JG�6� 4419`440 � JOBSITE ADDRESS 69 Ellis Circle OWNER'S NAME Erik Tolley GOWNER ADDRESS same TEL FAX • TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL a PRINT CLEARLY NEW:❑ RENOVATION:D REPLACEMENT:CI PLANS SUBMITTED: YES NO❑ APPLIANCES 2 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I 1 BOOSTER L_ 1 I CONVERSION BURNER COOK STOVE f W-; jai - 1, 2,-, DIRECT VENT HEATER DRYER inspiptinjoisi: FIREPLACE FRYOLAT FURNACE ��II�MP, PMNMI Ina GENERATOR GRILLE INFRARED HEATER �M iltinn� n_ LABORATORY COCKS 11111:1 no 0 MAKEUP AIR UNIT OVEN RN POOL HEATER 1 0111114! ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATERii I UNVENTED ROOM HEATER WATER HEATER OTHER I JIR 111111110;11 INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 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. S And PLUMBER-GASFITTER NAME Tygue S Reed LICENSE# 15200 I JJJ SIGNATURE MP El MGF❑ JP❑ JGF❑ LPG'❑ CORPORATION❑# PARTNERSHIP❑# LLC Q# 4047C COMPANY NAME: Coastal Mechanical ADDRESS 299 Whites Path CITY South Yarmouth STATE MA ZIP 02664 -_.. TEL 508-737-8747 FAX 508-760-5800 CELL 508-246-9599 EMAIL'lisa©coastalphc.com ': -."''_-_- ' •' i.: hi I I I I I JUL 31 2018 1 149 E-