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HomeMy WebLinkAboutBLDG-22-006551 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '1 CITY YARMOUTH MA DATE May 15,2022 PERMIT# BLDG-22-006551 JOBSITE ADDRESS 19 MAYFLOWER RD OWNER'S NAME PLATT ROBERT LEONARD TRS G OWNER ADDRESS PLATT STEPHANIE ANN SCHUSTER TRS 302 ELLIOT RD CENTERVILLE MA 02632 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 1 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Kevin McBride LICENSE# 11620 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Kevin McBride Plumbing and Heating,Inc. ADDRESS. 11 Cocheset Path, CITY West Yarmouth STATE MA ZIP 026732559 TEL 15087784556 FAX CELL 5083643724 EMAIL 1 S310N M31A3LI NVId #111N2f3d $:333 11WJ3d 3E11 SV S3A83S NOIIVOIlddV SIHI oN seA S310N N01103dSNI 1VNIH AINO 3Sfl N0103dSNI d03 30Vd SIHI S310N N01103dSNI SVO HOflO