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HomeMy WebLinkAboutBLDG-22-002107 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK m0 CITY YARMOUTH MA DATE October 13,2021 PERMIT# BLDG-22-002107 Ii JOBSITE ADDRESS 80 MATTAKESE RD UNIT 2 OWNER'S NAME BRENNAN WALTER C JR G OWNER ADDRESS 80 MATTAKESE RD UNIT 2 WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 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 i OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 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 Vincent Marino LICENSE# 15136 SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPG' ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: Best Yet Installations Inc ADDRESS. 10 Meadow Rd, CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL S310N MJIA3H NVId #111N83d $:33d ❑ ❑ ±I N 2d 3H1 SY S3AN3S NOI1VOIlddv SIHI ON s@A S31ON NO1103dSNI IVNId AINO 3Sf1 N0103dSNI 210d 3OVd SIH1 S310N NO1103dSNI SVO HOf108