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HomeMy WebLinkAboutBLDG-23-004202 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . CITY YARMOUTH MA DATE January 30,2023 PERMIT# BLDG-23-004202 ff JOBSITE ADDRESS 303 ADMIRALTY HEIGHTS VILLAGE OWNER'S NAME FRANKLIN MICHAEL C G OWNER ADDRESS FRANKLIN JILL H 1 LEXINGTON CIR CANTON MA 02021 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL EI CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO El 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 © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY CI BOND El 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 Christopher Menslage LICENSE# 3871 SIGNATURE MP❑ MGF © JP El JGF El LPG! ❑ CORPORATION El# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: All Gas Heating&Cooling Inc. ADDRESS. 15 Jan Sebastian Dr.E5, CITY Sandwich STATE MA ZIP 025630550 TEL FAX CELL 5082740831 EMAIL