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HomeMy WebLinkAboutBLDG-22-006961 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 9 CITY YARMOUTH MA DATE [June 02,2022 I PERMIT# BLDG-22-006961 JOBSITE ADDRESS 111 ROUTE 6A OWNERS NAME BARRON MELANIE H G OWNER ADDRESS 111 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 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/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 Q 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 Alex Braga LICENSE# Massachusetts SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Braga Brothers Inc ADDRESS. 110 breeds hill road Unit#5, CITY Hyannis STATE MA ZIP 02601 TEL 5088274260 1 FAX CELL 7744870199 I EMAIL S310N M31A32i NVld #iI012i3d $:333 ❑ El 1I N f3d 3Hl SV S3Aid3S N011v'OIldd`d SIHl oN se), S310N NO1103dSNI 1YNId AlNO 3Sfl 2i0103dSNI 210d 39Vd SIH1 S31ON NO1133dSNI SVD Fiona'