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HomeMy WebLinkAboutBLDG-20-005822 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ur cj CITY YARMOUTH =kMA DATE May 14,2020 PERMIT# BLDG-20-005822 JOBSITE ADDRESS 20 TALL PINES DR OWNER'S NAME ARMEEN CLAUDE J G OWNER ADDRESS BYRNE STEPHEN R 20 TALL PINES DR YARMOUTH PORT MA 02675-2517 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO 0 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 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 OTHER DESCRIPTION: r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ❑ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY 0 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 BRIAN SPRINGSTEEN LICENSE# 12593 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: CAPE COD OIL CO ADDRESS. PO BOX 993, CITY PROVINCETOWN STATE MA ZIP 02657 TEL FAX CELL 5087268081 EMAIL /I els.)(s )./o 6-tie -Mk/ S31ON M3IA3�1 NVld #lIV d $ :33d ❑ 0 11M3c1 3H1 SV S3AH3S NOI1V011ddd SIHl oN saA S31ON N01103dSNI 1VNId 11NO 3Sfl H10103dSNI 2iOd 2OVd SIHl S31ON N01103dSNI SVS HOf10?:1