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HomeMy WebLinkAboutBLDG-006016 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE 'April 20,2022 1 PERMIT# BLDG-22-006016 r gs JOBSITE ADDRESS VERNONC7 ST OWNERS NAME KOWALSKI RICHARD R G OWNER ADDRESS 27 VERNON ST WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO 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 I 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 LABILITY INSURANCE POLICY© OTHER OF INDEMNITY BOND ❑ OWNERS 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 'Richard Whiteside I LICENSE# 15850 SIGNATURE MP El MGF❑JP❑ JGF❑ LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IMurphv's Services,Inc ADDRESS. 134 White's Path, CITY 'South Yarmouth ISTATE MA ZIP 02664 TEL 15087601660 FAX CELL I EMAIL S310N M3IA3H NVld #IIIN2i3d $ :33d 1111 3d 3H1 SY S3A1:13S NOIlVOlddV SIHI ON SeA S310N N01103dSNI lYNId /LINO 3Sl 210103dSNI d0d 30Vd SIH1 S310N N01103dSNI WO HOl02i