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HomeMy WebLinkAboutBLDG-22-002346 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK klffr-5 CITY YARMOUTH MA DATE 'October 23,2021 I PERMIT# BLDG-22-002346 JOBSITE ADDRESS 42 EARLY RED BERRY LN OWNERS NAME IACOZZI CLAUDIA G OWNER ADDRESS 2 SEAN DR MANSFIELD MA 02048 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES El NO❑ 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 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 1 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY 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 at 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 Barry Arpin LICENSE# 9300 SIGNATURE MP El MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Arpin Plumbing Corp ADDRESS. PO Box 267. CITY East Taunton STATE MA ZIP 02718 TEL FAX CELL 7744061390 EMAIL S310N M3IA3?3 NYld #1IIN 3d $:33d 0 ❑ 1IIJ 3d 3H1 SV S3/1a3S NOI1VOIlddV SIHI ON SOA S310N N01103dSNI 1VNId AlN0 3Sl 210103dSNI 210d 3OVd SIH1 S310N NOI103dSNI St/0 HOflO I