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HomeMy WebLinkAboutBLDG-22-005803 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE April 11,2022 PERMIT# BLDG-22-005803 JOBSITE ADDRESS 16 SILVER LEAF LN OWNER'S NAME OBER SCOTT M G OWNER ADDRESS OBER STACEY A 16 SILVERLEAF LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ - RESIDENTIAL El PRINT CLEARLY NEW: 0 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 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 © NO❑ 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 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 Alan Bishop LICENSE# 31513 SIGNATURE MP 0 MGF 0 JP© JGF❑ LPG!0 CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME: A.W.Bishop Plumbing and heating ADDRESS. 23 denver st, CITY hyannis STATE MA ZIP 02601 TEL 7745529777 FAX 7745529777 CELL 7745529777 EMAIL S31ON M3IA321 NVld #11 VOnd $ :33d 111,1213d 3H1 SV S3/1213S NOIld01lddV SIHI oN s8A S2ION NO1103dSNI 1VN13 AlNO 3Sfl 2IO103dSNI 2JOd 39Vd SIHl S31ON NOIl03dSNI SVO HOf102i