Loading...
HomeMy WebLinkAboutBLDG-22-005830 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k-re'F CITY YARMOUTH MA DATE (April 12,2022 I PERMIT# BLDG-22-005830 r` JOBSITE ADDRESS 62 GREAT WESTERN RD OWNERS NAME 'Margaret Keras G OWNER ADDRESS MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT'.0 PLANS SUBMITTED:YES❑ 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 DIRECT VENT HEATER DRYER FIREPLACE 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Michael Saurette LICENSE# 34174 SIGNATURE MP❑MGF❑JP© JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: SAURETTE BROTHERS ADDRESS. 7 Bamhouse Road, CITY Dennisport STATE [Ma. ZIP 02639 TEL FAX CELL EMAIL dwallace33(thoutlook.com S310N M31A321 NVld #IIW2l3d $:33d ❑ ❑ 1I1/4213d 3H1 SY S3Ab3S NOIiV011dd`d SIHl ON saA SALON NO1103dSNI 1VNld ,LINO 3Sfl 210103dSNI dOd 3OVd SIHl SALON NO1103dSNI SVJ H9f102I ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING i, J4?` C� WORK Od" CITY $oc '1P1 UU MA DATE 1r 1 PERMIT f;. 2:Z— �5'3 d JOBSITE ADDRESS 6 a o-fPa f I/es rn rd / R -- r�tb5 DINNER'S NAME G OWNER ADDRESS TEL 617 3OC oq FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW:' RENOVATION; ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-4 FLOORS—• BEN 1 2 3 1 5 F 7 BOILER 9 10 11 12 13 14 BOOSTER CONVERSION BURNER ■ COOK STOVE ■ DIRECT VENT HEATER DRYER, FIREPLACE X FRYOLATOR FURNACE _ 11 III GENERATOR IGRRAE aLABORRTDHEATER JaORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER _ OTHER _---i GE I have a current lia bili insurance policy or its substantial equivalent whicINSURANCE Oh meets the requirements of MGL.Ch.142 YES I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW NO O LIABILITY INSURANCE POLICY N- OTHER TYPE INDEMNITY ❑ BOND El 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 OP,AGENT CHECK ONE ONLY: OWNER ❑ AGENT El I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accuf to to the best of my knowledge `- and that all plumbing work and installations performed under the permit issued for this application will be in compile :rag ertin rovisi of the �` Massachusetts State Plumbing Code and Chapter 142 of the 4 L Pt General Laws. � zn PLUMBER-GASFITTER NAME LICENSE# 34 17 4- 'IGNATMS MP ❑ MGF❑ JP XJ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP El LLC❑# COMPANY NAME 5aU F IC 6rU ADDRESS 7 Ba rn house c CITY 1,/C nn -p06-1- STATE MA ZIP 0016 3 q TEL l ZT / 7o ? FAX CELL EMAIL R5oXSs ,yvMyl I.co UGH GA i 4SMSPECTIQNi4GTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: v PERMIT it PLAN REVIEW NOTES Margaret&Kevin Keras 62 Great Western Road South Yarmouth,MA 02664 April 5,2022 TO WHOM IT MAY CONCERN: PROPERTY ADDRESS: 62 Great Western Road South Yarmouth,MA 02664 Change of Plumbing Contractor Effective immediately please change the plumber of record FROM: Phillip J.Durfee-License 13774 TO: Michael Saurette-License 34174 Sincerely, Margaret Keras Property Owner mbkeras@gmail.com 617-306-2092