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HomeMy WebLinkAboutBLDG-22-005355 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK q w4 CITY 'YARMOUTH I MA DATE March 24,2022 PERMIT# BLDG-22-005355 II JOBSITE ADDRESS 44 MADISON AVE OWNER'S NAME MARSHALL SHAWN G OWNER ADDRESS 44 MADISON AVE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO El 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 _ OTHER 1 OTHER DESCRIPTION:Gas stove. 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 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 sigiature 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 Sullivan LICENSE# 13041 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Ready Rooter,Inc. ADDRESS. P.O.Box 371, CITY Sandwich STATE MA ZIP 02563 TEL 5088886055 FAX -I CELL EMAIL S3LON M3IA321 NVId #1IkN 3d $ 33d ❑ ❑ 11112Ed 3H1 SV S3A?J3S NOIlVOIlddV SIH1 oN saA S31ON NO1103dSNI 1VNId AINO 3Sf1 210103dSNI 21Od 30Vd SIH1 S31ON NO1103dSNI SVO HOfOJ