HomeMy WebLinkAboutBLDG-22-006772 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
,'�.,' : CITY 'YARMOUTH MA DATE May 23,2022 PERMIT# BLDG-22-006772
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JOBSITE ADDRESS 118 LAVENDER LN OWNER'S NAME (WATTS WARREN T JR TRS
G OWNER ADDRESS WATTS CAROLYN S TRS 18 LAVENDER LN WEST YARMOUTH MA 02673 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID
PRINT
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES 0 NO 0
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 0 OTHER OF INDEMNITY 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.
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 (Vincent Marino 'LICENSE# 115136 I SIGNATURE
MP Di MGF 0 JP 0 JGF 0 LPG( ❑ CORPORATION 0#I PARTNERSHIP 0#I LLC ❑#
COMPANY NAME: (BEST YET INSTALLATIONS INC I ADDRESS. 110 Meadow Rd,
CITY (Spencer I STATE MA ZIP 101562 I TEL 15088852378
FAX 1 I CELL 1 I EMAIL Ipermits(a),bestvetinstallations.com
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-91� CITY \ I MA DATE' PERMIT# Z 2" Z
JOBSITE ADDRESS �C\( {rlo C,V ,(Y , e]OWNER'S NAME u\�G r` 1 LJkn` -k'S _
G OWNER ADDRESS ch i _._ 71
TEI ..' ._S` & .FAX j
TYPE OR OCCUPANCY TYPE COMMERCIAL r 1 EDUCATIONAL Fl RESIDENTIAL IVI
PRINT
CLEARLY NEW:j 1 RENOVATION: REPLACEMENT: �/„J PLANS SUBMITTED: YES Li NO I
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER t 111111 , -
�
BOOSTER ! 'L _ . n .__ . v .. ... , I ..
CONVERSION BURNER [ p .'
i t
COOK STOVE � �
DIRECT VENT HEATER � 1 I i 1'
DRYER ,_ i ._a. -_ i - -
FIREPLACE - : __ *i: 1 �_. !_a • . _ -
Ti Th
FRYOLATOR _..
FURNACE Mr MIM
GENERATOR ,., ,I "_ __,ii i s. i I
��GRILLE _- _ t ;s i- i IL t , _,..__.:I
INFRARED HEATER .. .
LABORATORY COCKS _ I
MAKEUP AIR UNIT I i, _ 1 .�_n
_ a.
nit
ma
OVEN HEATER I ._._.., E� . . �.. . .. I.. _.. .
1
ROOM I SPACE HEATER I l >
ROOF TOP UNIT .. �.
TEST f _ _ . ,. . .L .. i,
UNIT HEATER 5 '' x i
UNVENTED ROOM HEATER Iv '
WATER HEATER IIIIII, G..�.. !__. :_.. G. t _.... �_. : ; i .,
OTHER 9 WIITAIIMUIM .. . : .;
I
i 1 II
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES FiNO
ri
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
$-SD
LIABILITY INSURANCE POLICY 21 OTHER TYPE INDEMNITY 0 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.
CHECK ONE ONLY: OWNER FL AGENT ri
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 ert'nent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
L,— ----,
PLUMBER-GASFITTER NAME \ \r y3- J LICENSE#'1S1 a° i SIGNATURE
N PARTNERSHIP #L LLC #[
MP� MGF 7 JP�' JGF� LPG! CORPORATION�#�>�O 53 G_; � �.._ ,
COMPANY NAME: 3t Ye,-- f GilCtItt .., r C ADDRESS—
CITY e.in ,s STATE tAniZIP S __.iTEL _e:��5a3 7C, I
FAX o! CELLS IEMAIL T ' 1 ? -(' C fi ZS .±tY1a I I., - ._._.. _ _::_��N..,� J