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HomeMy WebLinkAboutBLDG-22-003532 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 26,202'PERMIT# BLDG-22-003532 Ir JOBSITE ADDRESS 183 ROUTE 28 OWNER'S NAME THE COVE AT YM ASSOC LTD PTNRS G OWNER ADDRESS %VACATION RESORT INTERNATIONAL PO BOX 399 HYANNIS MA 02601 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL❑ PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES 0 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 FRYCLATOR • 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 1 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 0 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 at 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 William Heath LICENSE# 12021 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: B&H Service Company ADDRESS. 45 Main Street, CITY Sandwich STATE 1MA ZIP 02563 TEL 5087761005 FAX CELL 7744879170 EMAIL S310N M31A3d NVld #1II'JH d $ :33d ❑ 0 1I111213d 3H1 SV S3M:13S NOILVDIlddd SIHl oN Sa,I S310N N01133dSNI 1VNId AlNO 3Sfl?:J0103dSNI K3 9OVd SIHl S310N NOI103dSNI SVD HJl0H