HomeMy WebLinkAboutBLDG-21-000097 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
to ;" CITY S YARMOUTH —1 MA DATE 7/2/2020 PERMIT#(!ii?b-N-' V 97
JOBSITE ADDRESS 27 GRANDVIEW DR,S Y —1OWNER'S NAME PETER QUINLAN
OWNER ADDRESS 66 POOR ST,ANDOVER 01810TEL 978-807-6798 --PAX_ _
TYPE OR OCCUPANCY TYPE COMMERCIAL0 EDUCATIONAL Li RESIDENTIAL LI
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CLEARLY NEW:O RENOVATION:El REPLACEMENT:LI PLANS SUBMITTED: YES 1:1 NO•
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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 0 NO Li
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY L BOND LI
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 _ AGENT i i
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 tot of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit a •r ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME R Peter Checkowa j LICENSE#11-3417 N''ATURE
MP LA MGF D JP JGF 0 LPGI Li] CORPORATION 0#l i PARTNERSHIP L•, LLC L J# 1
COMPANY NAME: Checkoway Enterprises ADDRESS[11 Scargo Hill Rd
CITY Dennis 1 STATE MA ZIP 02638 TEL 508-385-1911
FAX 508-385-6858 j CELL 508-735-9993 EMAIL checkent at comcast.net J