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HomeMy WebLinkAboutBLDG-23-9764 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • 'VLF CITY YARMOUTH , MA. DATE 12/11/2023 PERMIT#13rDG-23-q74 o JOBSITE ADDRESS 100 HEATHERWOOD DRIVE,ROUTE 6A OWNER'S NAME HEATHERWOOD AT KINGS WAY rj OWNER ADDRESS: YARMOUTHPORT TEL: 508-362-9889 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL, EDUCATIONAL 0 RESIDENTIAL, PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO M FIXUTRES 1 FLOOR-. Bsmt 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 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 3 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0 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 ❑ AGENT❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this application -true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicati 6� ill be in • 'fiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` - . PLUMBERIGASFITTER NAME: LEON E CLARK,JR. LICENSE# 117344 SIGNA' RE COMPANY NAME: TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE CITY: SOUTH DENNIS STATE: MA ZIP: 02660 ] FAX 508-385-9177 TEL: 508-385-8868 CELL: 508-367-1452 EMAIL: karen@tcplumbing.net MASTER© JOURNEYMAN 0 LP INSTALLER 0 CORPORATION (PARTNERSHIP 0#1 1LLC 0#1