HomeMy WebLinkAboutBLDP-20-0000014 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK
1._a� ; CITY South Yarmouth MA DATE 06/26/2019 PERMIT# / 2b aO-0000/`�
JOBSITE ADDRESS` 15 Bass River Terrace OWNER'S NAME Joe Celona
OWNER ADDRESS SAME TEL 978 505 0262 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
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CLEARLY NEW:- RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO
APPLIANCES- FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER x n
BOOSTER
CONVERSION BURNER
COOK STOVE x
DIRECT VENT HEATER
DRYER
F:.
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
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LABORATORY COCKS
MAKEUP AIR UNIT
OVEN _..
POOL HEATER
ROOM/SPACE HEATER 43
ROOF TOP UNIT � .
TEST •
UNIT HEATER :..
UNVENTED ROOM HEATER
WATER HEATER ,..,. '
OTHER �
fl
•. w , �._. ..,_- INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES v; NO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i OTHER TYPE INDEMNITY BOND I
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 i 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 accura to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian . all ertinent rovision f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME KEVIN G. SARGENT LICENSE# 16471-M ATURE
MP MGF JP JGF LPGI CORPORATION i # 4117 PARTNERSHIP # , LLC q#'
COMPANY NAME: CAPE COD GAS HEAT&A/C SYSTEMS ADDRESS 15 JAN SEBASTIAN DRIVE#D4
CITY SANDWICH STATE MA ZIP 02563 TEL 508-539-9303
FAX 508-833-9389 CELL 617-834-0785 EMAIL INFO@CAPECODGAS.COM
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