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HomeMy WebLinkAboutBLDG-22-003432 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORKk—A c 11 CITY YARMOUTH MA DATE December 16,202'PERMIT# BLDG-22-003432 JOBSITE ADDRESS 38 WITCHWOOD RD OWNERS NAME FECTEAU PETER L G OWNER ADDRESS GRABENBAUER SHARI 38 WITCHWOOD RD SOUTH YARMOUTH MA 02664-2909 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO 0 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 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 0 NO❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY BOND 0 OWNERS 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 COREY SIBBIO LICENSE# 24795 SIGNATURE MP 0 MGF❑JP Q JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP 0# ILLC❑# COMPANY NAME: ADDRESS. 7 GLENEAGLE DR, CITY CENTERVILLE STATE MA ZIP 02632 TEL FAX CELL 5086854605 EMAIL S31ON M3IA3 NVld #1IW13d $ :33 ❑ ❑ 111/1183d 3H1 SV S2A83S NOLLVOIlddV SIH1 oN saA S310N NOI103dSNI 1VNL AINO 3Sfl N0103dSNI 2jOd 30dd SIHl S3ION NO1103dSNI S'dh HJl02i