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HomeMy WebLinkAboutBLDG-20-005853 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ' --_,) ari— ww CITY YARMOUTH MA DATE May 15,2020 1 PERMIT# BLDG-20-005853 JOBSITE ADDRESS 38 WILSON RD OWNER'S NAME fv1ARTINELLO MICHAEL J G OWNER ADDRESS 38 WILSON RD WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 1-3 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO Q 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 GRILLE INFRARED HEATER —4— LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 ROOM/SPACE HEATER ROOF TOP UNIT r TEST 1 UNIT HEATER I UNVENTED ROOM HEATER WATER HEATER OTHER l 1 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 knowieuge and that all plumbing work and installations performed under the permit issued for this application will he in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Tygue Reed LICENSE# 15200 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑#1 -.-1 COMPANY NAME: I ADDRESS. 9 Melissa Ave, CITY Mashpee STATE FMA-1 ZIP 02649 1 TEL FAX CELL 5082469959 EMAIL L,ll— / S310N M3 Aal NV-Id #.11wdad $ 33d ❑ ❑ 1101H3d 3H1 SV S3AH3S NOIIVOIlddV SIHI oN saA S31ON NO1103dSNI 1VNId AlNO 3Sf H010]dSNl 2iOd 3OVd SIHI S31ON NOI1ORdSNI Sb'0 HJl0H