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HomeMy WebLinkAboutBLDG-22-006608 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE May 17,2022 PERMIT# BLDG-22-006608 JOBSITE ADDRESS 168 CLEVELAND WAY I OWNERS NAME Daniel O'rourke G OWNER ADDRESS 02888-5541 TELI TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q 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 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 0 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 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd. CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL permitsanbestvetinstallations.com S310N M3IA3b NVld #LI 1 J d $:33d ❑ ❑ 11Wb3d 3H1 SV S3AH2S NOLLVOIlddd SIH1 oN saA S310N N01103dSNI 1VNId A1N0 3Sfl 10103dSNI 2IOd 3OVd SIHI S310N N01103dSNI SVO HOf108 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK s CITY k MA DATE c.' PERMIT # L 1 c_ S. JOBSITE ADDRESS `c . A_C,11 A C'%VI e _..0 Ct OWNER'S NAME PC,t1y1t k L�( ()QV" OWNER ADDRESS U1� TELgQI • '`fdc1• ddoci.`_,: FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: J PLANS SUBMITTED: YES NO ✓ APPLIANCES 1 FLOORS--► BSM 1 2 3 4 5 6 7 8 9 14 11 12 13 14 BOILER � �� — - - — — i BOOSTER CONVERSION BURNER COOK STOVE I DIRECT VENT HEATER DRYER FIREPLACE i 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 I WATER HEATER OTHER —71Np INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES /NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND 1). CD 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 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r'' • i PLUMBER-GASFITTER NAME \if k r\(./ 1 -kCc.\rtkne LICENSE # ,( ; j 2,(c V SIGNATURE ig//' . MP MGF JP JGF LPG! CORPORATION /# Lit 5 :3 G PARTNERSHIP # LLC # COMPANY NAME: :c--)2'63-t- ��� . - 'lS- ifiC't-�iL 15 `1-iiG. ADDRESS VO 4_,Ctoo1;'C) CITY �\-_,V. l C eX" STATE ,(Ar ZIP M ( TEL 5-a- �5 ` 5 z x FAX ;'UTAS• 3-7 CELL EMAIL _ye-6.1 I-{rS ='r b-G 5`+- e* tn3 vc 4 ons . cowl