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HomeMy WebLinkAboutBLDG-20-003984 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " BLDG-20-003984 If— CITY YARMOUTH MA DATE January 17,2020 PERMIT# JOBSITE ADDRESS 1 DANCING BROOK RD OWNER'S NAME ABRUNZO GAIL ANN G OWNER ADDRESS 1 DANCING BROOK RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 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 . LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 Kevin Sweeney LICENSE# 20883 SIGNATURE MP❑ MGF 0 JP 0 JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: ADDRESS. '62 Eureka street, CITY Worcester STATE MA ZIP 01603 TEL FAX CELL EMAIL S310N M31A32i Ndld #11WH3d $ :33d ❑ ❑ II1Al2 3E11 SV S3A213S N011v011ddy SIHI oN seA S310N NO1103dSNI 1VNId K1NO 3Sf1 2:10103dSNI elOd 39Vd SIHI S310N NO1103dSNI SVO HJf102i