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HomeMy WebLinkAboutBLDG-23-000355 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YYARMOUTH I MA DATE IJuly21,2022 I PERMIT# BLDG-23-000355 • JOBSITE ADDRESS 19 LAKE RD J OWNER'S NAME FEELEY JAMES R G OWNER ADDRESS FEELEY ROBIN M 19 LAKE ROAD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 1 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 0 IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY❑ 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 at 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 Ryan Latour LICENSE# 16991 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑#I ILLC❑# COMPANY NAME BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd, CITY STATE ZIP TEL FAX l J CELL EMAIL permits(olbestyetinstallations.com S310N M3IA32:1 Ndld #11W213d $ :3Ad O ❑ 11141d3d 3H1 SV SAS N011vollddb SIHI oN saA S31ON NO1103dSNI 1VNl3 AlNO 3Sl):10103dSNI 2IOd 3OVd SIH1 S31ON NO1103dSNI SVO HJf10% MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1.- J -- - ,1,-)? 7- CITY �_\i' . \ICi11�IY1t MA DATE q / o,� ? PERMIT # 21-- o 3 5 S JOBSITE ADDRESS ` el Lct v-C.. ie-, . OWNER'S NAME 'K O 'e. C le . fi OWNER ADDRESS Ole, TEL SCE;' -=} 34' 9 I 3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL n EDUCATIONAL ❑ RESIDENTIAL rif PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: d PLANS SUBMITTED: YES ❑ NO [I APPLIANCES 1 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 a INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE ,( I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [J NO , I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE INDEMNITY n 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 1r 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 complia ith all I rtinen ro sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. J c PLUMBER-GASFITTER NAME 'y t,� V L a-KA ( LICENSE # Mg5GJl T SIG RE MP i MGF IIIJP ❑ JGF n LPGI ❑ CORPORATION d# I S 3 C PARTNERSHIP n # LLC fl # COMPANY NAME beic54 kit* -I1Sfiei I/ G (oh S Inc,. ADDRESS l() Ae COOkkj iZGj . CITY y C� +( STATE S 1,1 ZIP ( I S (GR TEL 50?- Mc. , 3. x 1 FAX SC) — S ` 3 CELL EMAIL 1.7C01 kS retie j-;Lie,-+ inYi-6111+` ti 5 , CC,rrl