Loading...
HomeMy WebLinkAboutBLDG-18-006289 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,e CITY YARMOUTHk., MA DATE May 09, 2018 PERMIT# BLDG-18-006289 r JOBSITE ADDRESS 176 CRANBERRY LN OWNER'S NAME GARRISON INDUSTRIES LLC G OWNER ADDRESS C/O STEPHEN BURKE 19 OLDE COLONY LN CAPE ELIZABETH ME TEL 04107 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YESD NOD 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 OTHER tr.r;Lel- L.i tiL 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 Saunders LICENSE# 4546 SIGNATURE MP❑ MGF© JP❑ JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: KEVIN C SAUNDERS ADDRESS 67 HELMSMAN DR, CITY YARMOUTH PORT STATE MA ZIP 026752467 TEL FAX CELL EMAIL S31ON M3IAal NV1d #±I1Ab3d $ 33d ❑ !Mad 3H1 SV S3A J2S NOLLV3Ilddd SIH1 oN saA S31ON NO11O3dSNI 1`dNId A NIO 3Sf1 2iO1O3dSNI 21Od 30Vd SIH1 S31ON NOLLO3dSNI SVO HOfO2i