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HomeMy WebLinkAboutBLDG-22-002755 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK wn-S� BLDG-22-002755 ii_ 4 CITY YARMOUTH MA DATE November 14,2021 PERMIT# JOBSITE ADDRESS 52 LOCUST ST OWNER'S NAME BLUE WATER LIMITED PARTNERSHIP G OWNER ADDRESS 20 NORTH MAIN STREET SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ED PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 , 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 _ , 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 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 Jeffery ricardo LICENSE# 13256 SIGNATURE MP El MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: patriot plumbing inc ADDRESS. 538 federal furnace rd, CITY plymouth STATE MA ZIP 02360 TEL 5088464551 FAX CELL EMAIL S31ON M3IA3a NVId #1I1A1213d $ ❑ ❑ 111,1213d 3H1 SV S3A?J3S NOIJVOIlddV SIH1 ON SaA S31ON NO1103dSNI 1VNld AINO 3Sfl a0103dSNI NOd 39Vd SIH1 S310N NO1103dSNl SVJ HJfOa