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HomeMy WebLinkAboutBLDG-21-006905 r r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _,1 CITY YARMOUTH MA DATE May 27,2021 PERMIT# BLDG 21-006905 11j `. � JOBSITE ADDRESS 111 STARBUCK LN OWNERS NAME GARNHUM DANIEL P G OWNER ADDRESS LEGER LINDA J 111 STARBUCK LN YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT PLANS SUBMITTED: YES El NO CLEARLY NEW: El RENOVATION:© REPLACEMENT:El El FIXTURES FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 ' 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY 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 Alex Braga LICENSE# MA SIGNATURE MP 0 MGF Q JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Braga Brothers Heating,Plumbing and Air C ADDRESS. 110 Breeds Hill Rd,Unit 5, CITY Hyannis STATE MA ZIP 02664 TEL 5088274260 FAX CELL 7744870199 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES