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HomeMy WebLinkAboutBLDG-23-001637 l 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r " CITY YARMOUTH MA DATE September 27,202 PERMIT# BLDG-23-001637 w ii JOBSITE ADDRESS 915 WEST YARMOUTH RD OWNERS NAME IENGARD JASON G OWNER ADDRESS 915 WEST YARMOUTH RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ID 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 (Ryan Latour I LICENSE# 116991 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG! 0 CORPORATION 0#I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: (BEST YET INSTALLATIONS INC ADDRESS. 110 Meadow Rd, CITY ( STATE ZIP I I TEL I FAX I I CELL I I EMAIL Ipermits(a,bestyetinstallations.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tkr Ago? CITY)armbU+ln ?or+ MA DATE 01 a PERMIT# JOBSITE ADDRESS 5 IN U) OWNER'S NAME C( - COVII day GOWNER ADDRESS �G rn� TEL2O3•�'�34.3 4I J FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT: d PLANS SUBMITTED: YES❑ NO[71 APPLIANCES 1 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [r NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ni OTHER TYPE 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. CHECK ONE ONLY: OWNER g AGENT ❑ 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 complia - "th all INtinen J.ro sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -_ PLUMBER-GASFLTT-ER NAME 9 — L 614ok.)kr- LICENSE-#/(0 9q -J'✓j SIG'►:r" RE MP[J MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION[V]/#41 I S 3 C PARTNERSHIP❑# LLC❑# COMPANY NAME �,Q tl��- ThS-`-C,IIGt-tonS inC. ADDRESS Ih 1✓le coo uo (Z61 , CITY SP e r STATE Pk 171 ZIP ()3 (oa TEL SOS-M3S-• 3 3-IS x I FAX SO�-'n,S-•a339- CELL EMAIL pe`alii-ISa'be3- ye+ins-i-ctIIC-kbnS. Co n