Loading...
HomeMy WebLinkAboutBLDG-22-002995 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK — '— CITY 'YARMOUTH I MA DATE (November 23,2021 PERMIT# BLDG-22-002995 JOBSITE ADDRESS 130 LEWIS RD I OWNER'S NAME VARETIMOS LAMBRINI G OWNER ADDRESS VARETIMOS PETER 30 LEWIS RD WEST YARMOUTH MA 02673 1 TEL TYPE,OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES NO FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 _ 12 _ 1.3_14 BOILER BOOSTER _CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE • GENERATOR GRILLE • _ 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 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 ❑ OWNERS 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 (Craig Bishop I LICENSE# 15101 SIGNATURE MP El MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: (High Efficiency LLC I ADDRESS. I378-MA130. CITY ISandwhich ISTATE MA ZIP 02563 TEL 15088253695 FAX CELL EMAIL I S310N M3lA32:1 NVld #1l1N2A3d $ :33d 111APEd 3H1 Sd S3A213S NOLLV011ddd SIHJ oN saA S310N NOI103dSNI 1YNIH /ONO 3Sf H0103dSNI 39Vd SIHl SALON NOI133dSNI SVD HJf102�