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HomeMy WebLinkAboutBLDG-22-001153 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 14 CITY YARMOUTH MA DATE August 31,2021 PERMIT# BLDG-22-001153 JOBSITE ADDRESS 59 NAUTICAL LN OWNER'S NAME CARCHEDI BRIAN D G OWNER ADDRESS 59 NAUTICAL LN SOUTH YARMOUTH MA 02664 J TEL ] TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ 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 1 _ DIRECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLEINFRARED 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 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 Vincent Marino LICENSE# 15136 i SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# ] COMPANY NAME: Best Yet Installations Inc ADDRESS. 10 Meadow Rd, ] CITY Spencer STATE MA ZIP 01562 TEL 5088852378 ] FAX CELL EMAIL ] S310N M3IA321 NVId vS%ns/D / I VJ7 #111N2i3d $:33d S/fu VP'S VrNMQ ❑ ❑ 11W213d3HiSYS3A213SNOI1VOIlddVSIHl oN so), S310N N01103dSNI 1VNId AINO 3Sfl N0103dSNI 210d 30Vd SIHI S3LON N01103dSNI SVO HOl021