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HomeMy WebLinkAboutBLDG-19-003482 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK csCITY YARMOUTH MA DATE December 08,: PERMIT# BLDG-19-003482 a JOBSITE ADDRESS 11 CAPT DANIEL RD OWNER'S NAME KRIKORIAN JOHN P G OWNER ADDRESS KRIKORIAN DEBRA 11.CAPT DANIEL RD SOUTH YARMOUTH MA Ce, TEL 02664 h —027—gaOo TYPEOR OCCUPANCY TYPE COMMERCIAL 0 } RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION:❑' REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NOD 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/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 0 NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY El 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 Alex Braga LICENSE# 15668 SIGNATURE MP© MGC JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Braga Brothers, Inc. ADDRESS 110 Breeds Hill Rd, Unit 5, CITY Hyannis STATE MA ZIP 02601 TEL FAX [ CELL EMAIL Ar/ 79 SRION M2IA321 NVId #lVW2l3d $ :33d ❑ ❑iM1N2l3d 31-11 SV S3A213S NOIlVOI'lddV SII-11 oN sa,* SBION NOI103dSNI 1VNId .LINO 3Sl 210103dSNI 21Od 30Vd SIHJ S31ON NOI103dSNI SVO HJf1O2i