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HomeMy WebLinkAboutBLDG-22-004050 #A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY YARMOUTH MA DATE [January 20,2022 I PERMIT BLDG-22-004050 JOBSITE ADDRESS 1313A ROUTE 28 OWNER'S NAME LOW FOO CHON TRS G OWNER ADDRESS CHIU KINNIE TRS 1323 ROUTE 28 SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL I7 RESIDENTIAL El PRINT CLEARLY NEW: m 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 FRYOLATOR FURNACE GENERATOR 1 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 © NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME AARON SILVA LICENSE E MA SIGNATURE MP El MGF 0 JP 0 JGF El LPG[ El CORPORATION❑H PARTNERSHIP El A LLC❑# COMPANY NAME: AMS PLUMBING&HEATING ADDRESS. 1679 BEDFORD ST, CITY BRIDGEWATER STATE MA ZIP 02324 TEL 5083269677 FAX CELL 5083269677 EMAIL S310N M31A32:1 NVId #111/ 2i3d $ :33d El 1:1 1111H3d 3H1 SV S3A213S N011VDIlddV SIHl oN saA S31ON NO1103dSNI 1VNId A1NO 3Sl 210103dSNI 210d 30Vd SIHI S310N NO1103dSNI SYS HJl0H