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HomeMy WebLinkAboutBLDG-20-001877 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . AK CITY YARMOUTH MA DATE October 07,2019 PERMIT# BLDG-20-001877 If JOBSITE ADDRESS 8 SYRITHAS WAY OWNER'S NAME ELSBREE DAVID B TR G OWNER ADDRESS DAVID B ELSBREE 2006 REV TRUST 59 PRESIDENTIAL DR SOUTHBOROUGH MA TEL 01772 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ pe )(1( RESIDENTIAL C PRINT Qr"� I',, CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:El PLANS SUBMITTED: YES 0 NO❑ FIXTURES FLOORS—0 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 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 © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © 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 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 Tygue Reed LICENSE# 15200 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: TYGUE S REED ADDRESS. 78 SANTUIT POND RD, CITY MASHPEE STATE MA ZIP 026492421 TEL FAX CELL EMAIL lisa@coastalphc.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES R07"( 0/15 W I .F11474469 �A� �Ie dime) Z I i l c/ /_ _ 14, 3