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HomeMy WebLinkAboutBLDG-22-001249 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I}�► MA DATE (Se tember 02,202I PERMIT#P BLDG-22-001249 JOBSITE ADDRESS 126 OAK GLEN VILLAGE I OWNER'S NAME IPREZIOSI ROSANNA G OWNER ADDRESS IPREZIOSI LOUIS P 26 OAK GLEN YARMOUTH PORT MA 02675 I TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ElRESIDENTIAL El CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ FIXTURES FLOORS� PLANS SUBMITTED: YES ❑ NO El 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 1 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 0 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 'Albert Cassano I LICENSE# 19015 MP© MGF ElJP ElJGF ElLPG' ElCORPORATION❑#I I SIGNATURE PARTNERSHIP COMPANY NAME: (Cape Cod Mechanical Systems,Inc. I ADDRESS. 18 Fruean Way, ❑#I ILLC El#1 CITY (South Yarmouth ' IMA 'ZIP 02664 STATE ' I TEL 15083947501 FAX I I CELL 15087769536 I EMAIL I 1