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HomeMy WebLinkAboutBLDG-22-007186 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE (June 13,2022 I PERMIT# BLDG-22-007186 2d� a JOBSITE ADDRESS 259 LONG POND DR OWNERS NAME Tuyen Truonq G OWNER ADDRESS 259 LONG POND DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO 0 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 0 NO 0 IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND 0 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 0 LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd. CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL permitslSbestyetinstallations.com S310N M3IA3b NVld #JIW2d3d $:33d ❑ 0 111183d 3H1 SV S3A213S NOIIVOIlddV SIHI oN se), S3ION NOI103dSNI lYNId AlN0 3Sfl 101.03dSNI 23O 13JVd SIHJ S310N N01103dSNI Sd0 Fiona!I :_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1.4 _ e il CITY S . \ICAsavt06._- MA DATE Vi__a as PERMIT# •, JOBSITE ADDRESS.a,j ci Lwe Poxes OY. OWNER'S NAME r� ,f€ \ "C'uon 1 G OWNER ADDRESS �Vlet� TEL L-►bl-k099 • (4'0 FAX TYPE OR NCY TYPE COMMERCIAL EDUCATIONAL _ RESIDENTIAL IPRINT OCCUPANCY CLEARLY NEW: RENOVATION: REPLACEMENT: I PLANS SUBMITTED: YES NO / APPLIANCES 1 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 1 MAKEUP AIR UNIT [ OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER I - !" UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES /NO I have a current liability insurance p y q I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW %CD i LIABILITY INSURANCE POLICY 1 OTHER TYPE 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. 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 Pert}Went provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. it 4 // _ PLUMBER-GASFITTER NAME \J C� )\-i\a\r`k n0 LICENSE # \ , I . // SIGNATURE MP ✓ MGF JP JGF LPG! _ - CORPORATION /It II t 53 0 PARTNERSHIP # LLC # COMPANY NAME:TtS - ye,-t- - 1(1 {1(;f-- 7S �i�G. ADDRESS n YieCtdC.A0 • CITY 3petr\ C.e.,( STATE tAifi ZIP vs-coa TEL J - -1555 - g.3.-=7- J X I FAX So1- yS' " CELL EMAIL Teovi t-'. _ e b- 5-r e-- - ,n3'\-ct 1 1 ct uVv5 , COM