Loading...
HomeMy WebLinkAboutBLDG-22-006278 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "[ CITY YARMOUTH MA DATE May 02,2022 PERMIT# BLDG-22-006278 JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 14C OWNERS NAME Patricia Skinger G OWNER ADDRESS SOUTH YARMOUTH MA 02664 TEL[ TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© 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 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 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# 15136 SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME' BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd, CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL permitsnd.bestyetinstallations.com S310N M3IA321 NYld #JIIN2d3d $:33d ❑ ❑ II1012l3d 3H1 SV S3A1:13S NOI1VOIlddV SIHl ON s9A S310N NOI103dSNI 1VNId A1NO 3Sl 210103dSNI 2lOd 3OVd SIHI S310N NO1103dSNI SVO HJl0H - i.=l MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4? MA DATE[ PERMIT # 'Z -? .a CITY . \IO� _ c9� n :_;: r -- JOBS(TE ADDRESS [ 0.___. C \C\GIY ___ 7 'OWNER'S NAME Tck--ksr�Ci C & ..1.Y G , r OWNER ADDRESS � aye �_..:. TEy FAX - ,_on_. . TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL . RESIDENTIAL 1 PRINT CLEARLY PLANS SUBMITTED: YES {�.- NO`_ NEW: RENOVATION: REPLACEMENT: L . APPLIANCES Z FLOORS-i BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER BOOSTER _.. __ -_.-_ _ CONVERSION BURNER . ` 7--�- COOK STOVE DIRECT VENT HEATER DRYER I' FIREPLACE FRYOLATOR FURNACE ._ GENERATOR � � . ,z d — - GRILLE ! INFRARED HEATER LABORATORY COCKS f MAKEUP AIR UNIT _OVEN I. POOL HEATER L,. : ROOM ! SPACE HEATER ROOF TOP UNIT - TEST I ..__ UNIT HEATER _ �_ UNVENTED ROOM HEATER ¢ -. WATER HEATER r ___ - OTHER r. ._ __�.,__.., : _.�._ _ _ 1. ,,,,......... ___ __ , - - -_ _ __ rt INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO _4 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ST) LIABILITY INSURANCE POLICY ‘I OTHER TYPE INDEMNITY L. 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 /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 compliance with all ertnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7,1, / c ilic 11/i/bz, PLUMBER-GASFITTER NAME � \tr�`(� __ LICENSE #161 1 SIGNATURE 4 e MP ;, _ , MGF JP L JGF 0 LPG' CD CORPORATION 77/# rqi 53 PARTNERSHIP EI# I LLC LJ# _ COMPANY NAME: P y - Y ti JC16, ADDRESS _.l .,iqeceo ) Zei ., _�. wa CITY L5pe,VICee‘r__,_ .___...____,.___, ___..r__ ___ _,__________ STATE ; ZIP O1 (ocR TE ISb • ,5- r93_ - ..: .__ TEL j FAXtoli.43,57: 57-4--- CELL EMAIL I-f rJ '�' `I'V t.I..1 `1( VLS