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HomeMy WebLinkAboutBLDG-23-00142 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE 'July 11,2022 I PERMIT# BLDG-23-000142 JOBSITE ADDRESS 1 MONROE LN OWNER'S NAME SWANSON ERIC G OWNER ADDRESS SWANSON ELIZABETH V 1 MONROE LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL I=1 RESIDENTIAL El 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 1 FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER r \ f LABORATORY COCKS 1 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 LIABILITY INSURANCE POLICY© OTHER OF INDEMNITY El 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 Albert Cassano LICENSE# 9015 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑#r JLLC❑# COMPANY NAME: Cape Cod Mechanical Systems,Inc. ADDRESS. 8 Fruean Way, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX CELL EMAIL S310N M31A32i NVld #±IIAJ d $ :33d ❑ ❑ II1^2i3d 3H1 SY S3A 3S NOIlv011ddtl SIHI oN saA S310N NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 103 30Vd SIH1 S310N N01103dSNI SVD HOf1021