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HomeMy WebLinkAboutBLDG-22-002622 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK v� e CITY YARMOUTH J MA DATE (November 08,2021I PERMIT# BLDG-22-002622 I f JOBSITE ADDRESS 151 PARK AVE I 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 El PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR 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 1 OTHER DESCRIPTION:FIRE PIT INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO❑ 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 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# Massachusetts(MA) SIGNATURE MP 0 MGF 0 JP El JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Braga Bros,Inc. ADDRESS. 110 Breeds Hill Road Unit 5, CITY Hyannis STATE MA ZIP 02601 TEL 5088274260 FAX CELL 7744870199 EMAIL S3lON M3IA3H Ndld #iIW2i3d $ :33d 0 1IINH3d 3H1 SV S3A213S NOIIHOIldd`d SIHl oN saA S31ON NO1103dSNI 1VNId A1N0 3Sf1 H0103dSNl HOd 39b'd SIH1 SALON NO1103dSNl SvD HJf10d