No preview available
HomeMy WebLinkAboutBLDG-23-003189 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 08,202; PERMIT# BLDG-23-003189 Li—_ a JOBSITE ADDRESS 27 GRANDVIEW DR OWNER'S NAME Peter Quinlan G OWNER ADDRESS 27 GRANDVIEW DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 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❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: CHECKOWAY ENTERPRISES ADDRESS. 11 scargo hill rd,11 SCARGO HILL RD CITY DENNIS STATE MA ZIP 02638 TEL 5083851911 FAX CELL EMAIL checkent(7a,comcast.net n - P - i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I, 5, /,912/VL0 L ;TH MA DATE 1.2 J c l c?-. PERMIT# JOBSITE ADDRESSF7 C�'v.pNo 0 et...) v`, s y OWNER'S NAME PP7r GU1 O"J GOWNER ADDRESS (06 Pe, j a TEL IFAX TYPE OR OCCUPANCY TYPE COMMERCIALn EDUCATIONAL ( i RESIDENTIAL PRINT CLEARLY NEW:1 i RENOVATION:P REPLACEMENT: PLANS SUBMITTED: YESI I NO1 I APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER , BOOSTER IT - 1I_ _ 1 _... . __ 11 i r I rI I 11 r CONVERSION BURNER IMIIIIIIIIIIIImilmmusillWillaMMIIIMIN.1111,1111.111.1111 DIRECT VENT HEATER MINI, - , 1W1 MITIM.: MagigaIliMillir—MilliallIUM FIREPLACE MN moliiiii MMIOIIIIIIIIMIIIIIIIIIIIOIIIIIIIIIIIIIII MN! FRYOLATOR l0j' ii1II� 11i1' uq ' 11111110111111111. FURNACE 1 �1��_ �M GENERATOR GRILLE I! i�1 !rni„ 4,, INFRARED HEATER geoniingiAnra,ii,b9ji il�i����I iiii LABORATORY COCKS �� �I MAKEUP AIR UNIT i� I. OVEN i POOL HEATER ni, I �' it i __- ROOM/SPACE HEATER ROOF TOP UNIT : ,, TEST I I (�,� in I4411! , i i. UNIT HEATER I u I I UNVENTED ROOM HEATER !', WATER HEATER I I�__ � � OTHER �_ ��� Mil OMB NMI 111111111111111111.1111111111 MINI 1 ,l 1 1 ' I 1 i I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES NO i-I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1 i OTHER TYPE INDEMNITY 0 BOND 0 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 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 -- --st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance w: all ' --nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE# 13417 OCIATURE MP ° MGF JP(1 JGF I I LPG! CORPORATION❑# PARTNERSHIPS#I LLC—1# COMPANY NAME:1 Checkoway Enterprises ADDRESS 11 Scargo Hill Road CITY Dennis STATE MA ZIP 02638 1TEL 508-385-1911 FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net