HomeMy WebLinkAboutBLDG-22-004541 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE February 15,2022 PERMIT# BLDG-22-004541
JOBSITE ADDRESS 32&34 SEAVIEW AVE OWNER'S NAME MACARTHUR DOUGLAS
G OWNER ADDRESS MACARTHUR JEANNE L 423 LOWER COUNTY RD DENNISPORT MA 02639-2118 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES ❑ NO El
FIXTURES FLOORS BSM 1 1 2 3 4 5 6 7 8 9 10 11 12 13 4
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 1
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 El NO El
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 andrew levesque LICENSE# Massachusetts SIGNATURE
MP El MGF ❑ JP El JGF El LPGI ❑ CORPORATION El# PARTNERSHIP ❑# LLC ❑# ]
COMPANY NAME: HARWICH PORT HEATING AND COOLING ADDRESS. 461 LOWER COUNTY ROAD, ]
CITY Harwich Port STATE MA ZIP 02646 TEL 5084323959 ]
FAX CELL EMAIL ]
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