Loading...
HomeMy WebLinkAboutBLDG-22-000276 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTHk, MA DATE July 16,2021 PERMIT# BLDG-22-000276 JOBSITE ADDRESS 25 AUNT JANES RD OWNER'S NAME GROSECLOSE MARGARET SHAY G OWNER ADDRESS CIO PARSONS MICHAEL J 131 CRAFTS ST NEWTONVILLE MA 02158 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 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/SPACE HEATER ROOF TOP UNIT , TEST , UNIT HEATER , UNVENTED ROOM HEATER WATER HEATER 1 , 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 0 BOND 0 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 Kevin Sargent LICENSE# PL-16471-M SIGNATURE MP❑ MGF © JP❑ JGF❑ LPG! ❑ CORPORATION❑#_ PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Cape Cod Gas Heat&AC Systems ADDRESS. 15 JAN SEBASTIAN DR,UNIT 4D, CITY Sandwich STATE MA ZIP 02563 TEL 5085399303 FAX 5088339389 CELL 6178340785 EMAIL S310N M3IA321 NVId #1IW213d $:33d ❑ ❑ 11M13d 3H1 SV S3A213S NOIJV31lddV SIHl oN so), S310N N01103dSNI IVNId AINO 3Sfl NO103dSNI 210d 3OVd SIH1 S3ION NO1103dSNI SVO HJl0N