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HomeMy WebLinkAboutBLDG-22-005963 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE 'April 18,2022 I PERMIT# BLDG-22-005963 JOBSITE ADDRESS 101 MERCHANT AVE OWNER'S NAME HARRIS CAROLE G OWNER ADDRESS CARR LINDA J 101 MERCHANT AVE YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES El 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 DIRECT VENT HEATER DRYER • FIREPLACE FRYOLATOR FURNACE GENERATOR 1 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 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO 0 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 as 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 as Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 'Cameron Natale I LICENSE# 4600 SIGNATURE MP 0 MGF El JP❑ JGF❑ LPGI❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: I I ADDRESS. 200 Audreys Lane, CITY 'Marston Mills I STATE MA ZIP 02648 TEL 5087753083 FAX I I CELL 7743537354 EMAIL I S310N M3IA32:1 Wild #II W2i3d $:33d ❑ ❑ 11W213d 3H1 SV S3A2:13S NOI1VOIlddb SI1-11 oN saA S31ON NO1103dSNI 1VNId AlNO 3Sl 210103dSNI 2JOd 3OVd SIHI S31ON NOI103dSNI St/9 H9l0d