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HomeMy WebLinkAboutBLDG-22-004290 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �• • CITY YARMOUTH MA DATE February 02,2022 PERMIT# BLDG-22-004290 JOBSITE ADDRESS 23P WHITES PATH UNIT 6 OWNER'S NAME OSCAR TAYLORS LLC G OWNER ADDRESS 23 B2 WHITES PATH SUITE 5 SOUTH YARMOUTH MA 02664 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 I 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 III 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 Albert Cassano LICENSE# 9015 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Cape Cod Mechanical Systems,Inc. ADDRESS. 8 Fruean Way, CITY South Yarmouth STATE MA ZIP 02664 TEL 5083947501 FAX CELL EMAIL S310N M3IA3H NV-Id #1IN 3d $:33d ❑ 0 111NN3d 3H1 SV S3Ai13S NOI LV3IlddV SIN' ON so), S310N NO1133dSNI 1VNId AINO 3Sf1 N0133dSNI HOd 30Vd SIH1 S310N NO1133dSNI SVO H0l0N