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HomeMy WebLinkAboutBLDG-23-00041 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE July 05,2022 PERMIT# BLDG-23-000041 JOBSITE ADDRESS 229 OLD MAIN ST OWNER'S NAME DOWD ROBERT K G OWNER ADDRESS 3141 HOOD ST SUITE 650 DALLAS TX 75219-5026 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: 0 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 1 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 LABILITY 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 Vincent Marino LICENSE# 15136 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION❑it PARTNERSHIP ❑# LLC❑# COMPANY NAME: BEST YET INSTALLATIONS INC ADDRESS, 10 Meadow Rd, CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL permits(a?bestyetinstallations.com S31ON M3IA3H NVId #II1V:l3d $:33d ❑ ❑ 1IW213d 3H1 SV S3A213S NOIIVOI1ddV SIHJ ON SaA S310N NOI103dSNI 1VNI3 A1NO 3Sfl e10103dSNI 2IOd 3OVd SIHI S31ON NOI103dSNI SYJ HOf1021 sa. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . . . ... _A...._.� ._._.__. _.� .� MA DATEPERMIT# _ • yodyylo,mii_ 23 0w t t J CITY tp w , JOBSITE ADDRESS ado of e s•-t- OWNER'S NAME i6tYjct re-v bo,,ti,)G OWNER ADDRESS EL ` T TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ESIDENTIAL I PRINT Ti^ CLEARLY `'' NEW: RENOVATION: w REPLACEMENT PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS-4 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 '6a ..v-•. : -.,,,,,,.....4.,,,._--a�.a:wok.Fic_k�.-..n...:i'..a.J...^S3'._...i::.._.sv.. .T.�_..5. _]..�.?.i,: .... :.. ... .._ __..., - ..... ...... _- ....... .. ... _ ..... .. .. .. ,_ .. .. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL, Ch. 142 YES . /NO ] ^ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW a t350 LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND .w 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. CHECK ONE ONLY. OWNER ' /AGENT 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 alPertnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , f I� _ PLUMBER-GASFITTER NAME ...\\I, , -1 :..., .... Q\ tVA°- .a- LICENSE # 151,3 ` j SIGNATURE MP MGF JP Ti JGF ia... LPGI ` ^, CORPORATION # 53 G PARTNERSHIP # LLC t# COMPANY NAME: " _eSt YeA- ` S w5 _I-r)C. ADDRESS _.. CITY j� 'CV\Ce- .__:... ... ... _ STATE �'\nZIPQ ( 7 TEL c?7'_` `,� g 3 X. 1 . ,, ; � � TL . �� __FAX FAX`'U�j ?`J`3" - CELL EMAIL'Te,{0.�j j '�L' -e5�" e� " 't 't "..I..1 '"( .... 1._ �..�_...... ..��. ._,._._,