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Home My WebLink AboutBLDG-22-03741 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " CITY YARMOUTH MA DATE (January 05,2022 (PERMIT# BLDG-22-003741 JOBSITE ADDRESS 30 PHEASANT COVE CIR OWNERS NAME MIKLAVIC MARK F G OWNER ADDRESS 30 PHEASANT COVE CIR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ID 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 • • FRYOLATOR FURNACE _ - GENERATOR 1 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 El NO❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER OF INDEMNITY 0 BOND ❑ OWNERS 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 'William Holmes (LICENSE# 4592 SIGNATURE MP❑MGF 0 JP❑ JGF❑ LPG! El CORPORATION❑#' I PARTNERSHIP ❑#I ILLC 0# COMPANY NAME: (RCA Electrical Contractors 'ADDRESS. 19 Hunters Trail, CITY 'Sandwich 'STATE 'MA 'ZIP 1025632701 I TEL 15084280449 FAX I 'CELL' 'EMAIL ' 1 S310N M3IA3b NVld #111AN3d $ :33d 0 ❑ 1IV d 3H1 SV S3AM3S NOI1VOIlddV SIHl oN saA S31ON NO1103dSNI 1VNId AINO 3Sf12!0103dSNI 2IOd 3OVd SIH1. S310N NO1103dSNI SVO Fiona!