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HomeMy WebLinkAboutBLDG-23-001128 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rii_ CITY YARMOUTH MA DATE August 31,2022 PERMIT# BLDG-23-001128 F. "= JOBSITE ADDRESS 12 SALTWORKS LN OWNER'S NAME GREW THOMAS A G OWNER ADDRESS GREW VIRGINIA A 2 ATLANTIC AVE SOUTH YARMOUTH MA 02664-1610 TEL_ TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO FIXTURES FLOORS—0 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 UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:CONNECTING OUR PROPANE TANK TO PLUMBERS STUB. NO GAS LINE TO BE RUN. 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 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 CHRISTOPHER DAVIS LICENSE# MA SIGNATURE MP El MGF ❑ JP❑ JGF❑ LPGI © CORPORATION❑# PARTNERSHIP El# LLC ❑# COMPANY NAME: Eastern Propane ADDRESS. PO Box 1207,3 New Venture Drive, CITY South Dennis STATE MA ZIP 02660 TEL 5087602778 FAX CELL EMAIL S310N M3IA32!NVId #111Ala3d $:33d ❑ ❑ lIW2I3d 3Hl SV S3A213S NOI!V0IlddV SIH1 oN saA S310N N01103dSNI 1VNId AINO 3Sf1210103dSNI NOd 39Vd SIN1 S310N N01103dSNI SVO HOl021