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HomeMy WebLinkAboutBLDG-23-004421 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t-•=-" ,.------__ CITY (YARMOUTH MA DATE (February 09,2023 PERMIT# BLDG-23-004421 ir JOBSITE ADDRESS 122 MICHELLES PATH OWNERS NAME ISANTANGELO GAETANO G OWNER ADDRESS SANTANGELO IDA 28 FIELD RD MEDWAY MA 02053 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT PLANS SUBMITTED: YES ❑ NO CLEARLY NEW: ElRENOVATION:❑ REPLACEMENT:El 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 . GENERATOR . _GRILLE _INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 El 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 (Tracy Home 'LICENSE# 115 Jan Sebastian Dr,I.1 SIGNATURE MP❑ MGF © JP❑ JGF❑ LPG( ❑ CORPORATION❑#I I PARTNERSHIP 0# LLC ❑#1 I COMPANY NAME: ICAPE COD GAS HEAT&NC SYSTEMS I ADDRESS. 115 JAN SEBASTIAN DR STE 4D, 1 CITY (Sandwich I STATE MA ZIP 1025632356 1 TEL 15085399303 1 FAX 1 1 CELL 16178340785 I EMAIL I 1