HomeMy WebLinkAboutBLDG-19-002413 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
'4t5CITYYARMOUTH MA DATE October 23,201 PERMIT# BLDG-19-002413
JOBSITE ADDRESS 31 MOORING LN OWNER'S NAME HOYT E DONALD JR
G OWNER ADDRESS 31 MOORING LN SOUTH YARMOUTH MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL II I
PRINT
CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES❑ NO❑
FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER 1
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER •
DRYER - - - --- - _ -
FIREPLACE
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 1 •
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 0 NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 9 OTHER OF INDEMNITY 0 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.
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 Kevin Saunders LICENSE# 4546 SIGNATURE
MP❑ MGFD JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑#
COMPANY NAME: KEVIN C SAUNDERS ADDRESS 67 HELMSMAN DR, •
CITY YARMOUTH PORT STATE MA ZIP 026752467 TEL
FAX CELL EMAIL
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