Loading...
HomeMy WebLinkAboutBLDG-21-007499 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 0 CITY YARMOUTH MA DATE June 24,2021 PERMIT# BLDG•21-007499 JOBSITE ADDRESS 14 KINGSBURY WAY OWNER'S NAME CARBONE PHILIP C G OWNER ADDRESS CARBONE NANCE L 6 ADRIAN DR NO READING MA 01864 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT.❑ PLANS SUBMITTED:YES 0 NO FIXTURES FLOORS—, BSM 1 2 3 4 5 5 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 1 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❑ 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 squired 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 BRIGGS LICENSE# 12901 SIGNATURE MP©MGF 0 JP 0 JGF❑ LPG!0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: Briggs 8 Heino Co. ADDRESS. 36 Rolling Hitch Road,P.O.box 538, CITY Centerville STATE MA ZIP 02632 TEL 5087780816 FAX CELL 5084002529 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES