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HomeMy WebLinkAboutBLDG-22-006641 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '"' c� CITY YARMOUTH MA DATE May 17,2022 PERMIT# BLDG-22-006641 M V II JOBSITE ADDRESS 105 BAYVIEW ST OWNER'S NAME Joe Desousa G OWNER ADDRESS 105 BAYVIEW ST WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL En PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE 1 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 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 ❑ 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 r checkoway LICENSE# 13417 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: CHECKOWAY ENTERPRISES ADDRESS. 11 scarqo hill rd,11 SCARGO HILL RD CITY DENNIS STATE MA ZIP 02638 TEL 5083851911 FAX CELL EMAIL checkentacomcastnet =i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK A1 CITY WEST YARMOUTH MA DATE 5/12/22 — 7-1-PERMIT# — We`t/ JOBSITE ADDRESS 105 BAYVIEW ST,W Y I OWNER'S NAME JOE DESOUSA GOWNER ADDRESS 33 FISKMILL RD MILFORD TEL 508 922 9345 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT RESIDENTIAL 0 CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES LI NO LJ APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ' BOOSTER I CONVERSION BURNER COOK STOVE I DIRECT VENT HEATER DRYER FIREPLACE 4 FRYOLATOR FURNACE I� � I v_ I I I(. �, GENERATOR — GRILLE �I INFRARED HEATER ��_ m _ _ � , I_ . I LABORATORY COCKS x I r _ iin Lim sip mg in pm awls MAKEUP AIR UNIT , I {' i[njWillrn,-.7111-Xkllail! ____ Mil OVEN POOL HEATER f ROOM/SPACE HEATER ' " ROOF TOP UNIT _. I _ __ Ill _ . TEST UNIT HEATER UNVENTED ROOM HEATER I WATER HEATER - OTHER 1 , L.-_ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LJ NO , I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LE OTHER TYPE INDEMNITY Li 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 Li AGENT _J 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 t th t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with II rt' provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE# 13417 SIG -71 MP`�] MGF JP[ JGF I_ j LPG!_ , CORPORATION #( PARTNERSHIP #r 1 LLC L #17--____ -li �. �_ ,� COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scar o Hill Rd CITY Dennis l STATE[ --M—Al ZIP02638 JTEL1 508 385 1911 FAX 1508-385 6858 1 CELL(508-735-9993 'EMAIL checkent@comcast net