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HomeMy WebLinkAboutBLDG-20-001491 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 CITY YARMOUTH MA DATE September 17,201 PERMIT# BLDG-20-001491 JOBSITE ADDRESS 64 WAMPANOAG RD OWNER'S NAME SETO CAROL LEUNG G OWNER ADDRESS 660 PLEASANT STREET FRAMINGHAM MA 01701 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL En PRINT CLEARLY NEW: 0 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 BOOSTER • CONVERSION BURNER COOK STOVE 1 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 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 Frank Roderick LICENSE# 7794 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Crooked Pond Rd ADDRESS. CROOKED POND RD, CITY HYANNIS STATE MA ZIP 02601 TEL FAX CELL EMAIL Ji/a7/ /idft/0 -.//0 S310N MIA Ndld #11W2i3d $ :32d ❑ ❑ 1I1A213d 3H1 SV S3A2l3S NOI1MOIldd`d SIHJ ON SaA S310N N01103dSNI 1VNH JCINO 3Sfl JOI33dSNI 2i0d 3OVd SIH1 S31ON NO1133dSNI SVO HOf1021