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HomeMy WebLinkAboutG-19-123 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK MA DATE Jul BLDG-19-000123 I� CITY 'YARMOUTH y 05,2018 PERMIT# 1 JOBSITE ADDRESS Is KATES PATH VILLAGE OWNER'S NAME SEARS DONALD Q TRS G OWNER ADDRESS SEAS MARGARET S 8 KATES PATH YARMOUTH PORT MA TEL 026 5-1442 TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NOD FIXTURES FLOORS—. BSM 11 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR - GRILLE INFRARED HEATER LABORATORY COCKS I MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER i ROOF TOP UNIT TEST UNIT HEATER I UNVENTED ROOM HEATER I _ _ 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 9 NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 9 OTHER OF 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. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and informational haf'e submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations.-rformed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Coca a d Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Walter Nye I LICENSE# 32083 SIGNATURE MC MGF❑ JP© JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Nve Plumbing Si Heating ADDRESS 349 Great Western Road, CITY Harwich I STATE MA ZIP 02645 TEL FAX CELL 5082463349 EMAIL (fig— 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 ' I� I � I