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HomeMy WebLinkAboutBLDG-23-000455 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w' F CITY YARMOUTH MA DATE (July 28,2022 I PERMIT# BLDG-23-000455 JOBSITE ADDRESS I9- 2 PHEASANT COVE CIR OWNERS NAME David John G OWNER ADDRESS rL33483 TELI TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS—a 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 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION:frepit 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 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 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 r checkoway I LICENSE# 13417 SIGNATURE MP©MGF❑JP 0 JGF❑ LPG'0 CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: ICHECKOWAY ENTERPRISES I ADDRESS. 111 scargo hill rd,11 SCARGO HILL RD I CITY 'DENNIS I STATE MA ZIP 02638 TEL 15083851911 FAX I 1 CELL EMAIL Icheckenit7a.comcast.net 1 S310N M3IA3b NVld #iJW2i3d $:33d ❑ ❑ lIW2i3d 3H1 SV S3A213S NOIIVOIlddV SIHJ oN seA S310N N01103dSNI lVNI3 A1N0 3Sf1 b0103dSNI 2:10d 3OVd SIHI S310N N01103dSNI SVO HOf1021 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Slite-tv)i CITY YARMOUTHPORT MA DATE 7125/22 PERMIT # - c `r• JOBSITE ADDRESS 92 PHEASANT COVE CIRCLE, YPT OWNER'S NAME DAVID JOLIN OWNER ADDRESS 1 16 TALBOT DR, REHOBETH TEL 857-636-8187 !FAX 1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESEI NO APPLIANCES Z FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTERI_.... CONVERSION BURNER 1 COOK STOVE DIRECT VENT HEATER _ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE 1 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER . ROOM l SPACE HEATER f ROOF TOP UNIT TEST 1 _ _- UNIT HEATER _ UNVENTED ROOM HEATER WATER HEATER OTHER FIREPIT 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ' OTHER TYPE 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. CHECK ONE ONLY: OWNER AGENT 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 e bes of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with II inept provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway j LICENSE # 13417 NA URE MP MGF JP JGF LPGI CORPORATION —1# PARTNERSHIP ;# LLC I# I COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE l MA ZIP 02638 TEL 508-385-1911 FAX 508-385-6858 J CELL 508-735-9993 EMAIL checkent@comcast.net _