HomeMy WebLinkAboutBLDG-19-004997 141 P d z .-C 7 v; '' `,A,--
i _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
5 kfa,y CITY YARMOUTHPORT _ MA DATE 2-12-19 I PERMIT# /}4/) �� 7 r°
JOBSITE ADDRESS[24 BRATTLE DR,YPT
, 4 ____ ,OWNER'S NAME LORIGULLIVER-G
OWNER ADDRESS [SAME TELF
TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL LI RESIDENTIAL
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CLEARLY NEW:p] RENOVATION:0 REPLACEMENT: e.._I PLANS SUBMITTED: YES NO j
APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOOSTER II , illiA 11111111!!!!min
BOILER
CONVERSION BURNER
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COOK STOVE 1 ! i
DIRECT VENT HEATER _ .11,_ , _ I � I I '1
DRYER ! . L. 1111 ' 1
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FURNACEiM � I rI ! _
GENERATOR �� I
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INFRARED HEATER IMP
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LABORATORY COCKS f 1 ,
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UP AIR UNIT �� ;
POOL HEATER Ir.!
ROOM/SPACE HEATER 1111!1 '�' 111!nix
ROOF TOP UNIT i I II i I
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UNIT HEATER __,_ Milrning jUNVENTED ROOM HEATER inn ___ .--Iwo,--
WATER HEATER —_-- . __v
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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 Li NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY I i OTHER TYPE INDEMNITY BOND L]
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 __,_,j AGENT LI
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 Partin rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE# 13417 TURE
MP Pl MGF Li JP I 1 JGF J LPG'Li CORPORATION; ]# rw I PARTNERSHIP f #j m~ I LC ri# I
COMPANY NAME Checkoway Enterprises ADDRESS[_11 Scargo Hill Rd
CITY Dennis STATE j MA _]ZIP 102638 'TEL 1508-385-1911
FAX f 508-385-6858 j CELLL508-735-9993 EMAIL checkent@corncast.net J
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