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HomeMy WebLinkAboutBLDG-22-003507 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "F_r. CITY YARMOUTH MA DATE (December 23,202'I PERMIT# BLDG-22-003507 ' JOBSITE ADDRESS 340 ROUTE 6A OWNER'S NAME TOWN OF YARMOUTH G OWNER ADDRESS FIRE DEPT 1146 ROUTE 28 SOUTH YARMOUTH MA 026644463 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO El 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 GRILLE INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ _ ROOF TOP UNIT _ _ TEST UNIT HEATER 1 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❑ 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 at plumbing work and installations performed under the permit issued for this application will be in compliance with at Pertinent provision of the Massachusetts state Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Kevin Sullivan LICENSE# 13041 SIGNATURE MP❑MGF 0 JP❑ JGF 0 LPG! El CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Ready Rooter,Inc. ADDRESS, 17 Jan Sebastian Drive,Unit 16, CITY (Sandwich STATE MA ZIP 02563 TEL 5088886055 FAX CELL EMAIL S310N M3IA32i Ndld #iIINH3d $ :3d ❑ ❑ IIIVEd 3H1 SV S3A213S NOI1V011ddd SIHI oN saA S310N N01103dSNI 1VNld A1N0 3Sfl 210133dSNl HOd 39Vd SIIHI S310N NOIIO3dSNI St/0 HO 1OH