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HomeMy WebLinkAboutBLDG-22-006568 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 6 CITY YARMOUTH MA DATE (May 16,2022 'PERMIT# BLDG-22-006568 JOBSITE ADDRESS 34 FESSENDEN ST OWNER'S NAME Patricia Kasanovich G OWNER ADDRESS 34 FESSENDEN ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 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 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 LABILITY 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 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME (Vincent Marino I LICENSE 15136 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑H PARTNERSHIP ❑# LLC 0 it COMPANY NAME: (BEST YET INSTALLATIONS INC I ADDRESS. 110 Meadow Rd. CITY (Spencer STATE MA ZIP 101562 I TEL 15088852378 FAX I I CELL I I EMAIL IpermitsWbestyetinstallations.com S31ON M3IA321 NVld #IIWd3d $:33d ❑ ❑ 111,11bOd 3H1 SV S3A2f3S NOliVOIlddV SRL ON SeA S31ON NOI103dSNI 1VNId AlNO 3Sfl 80103dSNI 2IOd 3OVd SIHI S31ON NO1103dSNI SVO HOflO \` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Y yft\(10'10 1 MA DATE 5 IS I J4, PERMIT # JOBSITE ADDRESS 3, fy_\e„, � : ....._..�....._..___ OWNER'S NAME PC*YCACt �•l_1Say,OV,ch OWNER ADDRESS U�iM1 TEL . 1-f07 ` FAX FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL J PRINT / / CLEARLY NEW: RENOVATION: REPLACEMENT: J PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE k 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 _ 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 bcj-0 LIABILITY INSURANCE POLICY '� OTHER TYPE INDEMNITY BOND IT 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 i 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 Pert)nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME V\ CI '� ' ���L; � 4.1 LICENSE # \(; j . ,(4' V SIGNATURE MP 1 MGF JP JGF LPG! CORPORATION 7# /it 53 PARTNERSHIP # LLC # COMPANY NAME: es - y-1- - 11S-rck(ICt-KA13 _1776. ADDRESS n ���U��;- ,� . CITY 3pL11 Ge_X- STATE tAn ZIP CAS-Co TEL 5.a.- 93-7- CJ x FAX ).? .S`o73 CELL EMAIL �lrvi ►-}'S be5�"{f L�-!� t+�l5 t t G1' U�'} Co