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HomeMy WebLinkAboutBLDG-23-001228 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ; a CITY YARMOUTH 1 MA DATE September 07,202 PERMIT# BLDG-23-001228 JOBSITE ADDRESS 4 OAK GLEN VILLAGE OWNER'S NAME GALLAGHER MARLIS C TR G OWNER ADDRESS THE GALLAGHER TRUST 4 OAK GLEN VILLAGE YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 1 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 rreets 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 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 andrew levesque LICENSE# 15162 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: harwich port heating and cooling ADDRESS. 461 lower county road, CITY harwich port STATE MA ZIP 02646 TEL 5084323959 FAX CELL EMAIL S310N M31A321 NVId #1I1A1213d $ 33d ❑ 1IW213d 3H1 SV S3AN3S NOIIVOIlddV SIHl oN saA S310N N01103dSNI 1VNId AINO 3Sfl 210103dSNI 2JOd 30Vd SIHI S310N N01103dSNI SVJ HOf1021