HomeMy WebLinkAboutBLDG-19-000146 MASSACHUSETTS UNIFORM,APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
I€- CITY I SOUTH YARMOUTH I MA DATE!7/5/18 I PERMIT# 47/94.0/Y&
JOBSITE ADDRESS 97 SOUTH SHORE DRIVE UNIT 211 I OWNER'S NAME I OCEAN MIST BEACH RESORT I
GOWNER ADDRESS 197 SOUTH SHORE DRIVE I TEL 508-760-2640 FAX! ' I
TYPE OR OCCUPANCY TYPE COMMERCIAL[j EDUCATIONAL U RESIDENTIAL IA
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES U NOD
APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
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MAKEUP AIR UNIT311111MISIMIENSPREP11115111101119111.0111111.11111101111.00.11
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES a NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q+ OTHER TYPE INDEMNITY U BOND Q
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 a best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will compliance wiVt all Pe ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �(A
PLUMBER-GASFITTER NAME l:ADAM TRAYNER LICENSE#;3880 SI NATURE
MP MGF JP JGF❑ LPGI❑ CORPORATION j0#I 173 PARTNERSHIPiU#, LLC❑#i I
COMPANY NAME'ROBIES HEATING&COOLING I ADDRESS 1279 YARMOUTH RD
CITY I HYANNIS I STATE MA IZIP102601 ITEL1508-775-3083
FAX'508-534-1272 CELL'508-775-3083 EMAIL!MARY@ROBIES.COM
ROUGII GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 ❑ �[, /_ />/ 4N_C
FEE: S PERMIT# / ' ` CI�/o�,A1/4 (oJv(
PLAN REVIEW NOTES