Loading...
HomeMy WebLinkAboutBLDG-22-00884 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE August 17,2021 PERMIT# BLDG-22-000884 JOBSITE ADDRESS 51 PARK AVE OWNER'S NAME OSULLIVAN JULIA A G OWNER ADDRESS ,OSULLIVAN TIMOTHY CHRISTOPHER 32 BARNESDALE RD NATICK MA 01760 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: m 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 1 BOOSTER • CONVERSION BURNER COOK STOVE 1 1 DIRECT VENT HEATER DRYER • FIREPLACE 1 1 FRYOLATOR FURNACE GENERATOR GRILLE 1 • 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 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❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY 0 BOND 0 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 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 Alex Braga LICENSE# MA SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Braga Brothers Heating,Plumbing and Air Co ADDRESS. 110 Breeds Hill Rd,Unit 5, CITY Hyannis STATE MA ZIP 02664 TEL FAX CELL 7744870199 EMAIL S310N M31A321 NVId #111A1N3d $:33d 1IINH3d 3H1 SY S3ALI3S NOI1VOIlddV SIH1 ON SOA S31ON NO1103dSNI IVNId AINO 3Sfl a0103dSNI 210d 30Vd SIHI S310N NO1103dSNI SVO HOl0H