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HomeMy WebLinkAboutBLDG-18-000595 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE August 01, 2011 PERMIT# BLDG-18-000595 JOBSITE ADDRESS 57 NEPTUNE LN OWNER'S NAME OROURKE JOHN F G OWNER ADDRESS OROURKE ANN A 57 NEPTUNE LN SOUTH YARMOUTH MA 02664 TEL TYPE PI'.OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW ❑ RENOVATION:© REPLACEMENT:El PLANS SUBMITTED: YES❑ NOD 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 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES © NOD IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY El 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 Alex Braga LICENSE# 15668 SIGNATURE MP© MGF❑ JP❑ JGFE LPGI❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: ALEX B BRAGA ADDRESS 2 MOUNTWOOD RD, CITY MARSTONS MLS STATE MA ZIP 026482111 TEL FAX CELL EMAIL GAY f/ S31ON M3Inal NVld #iI1Al2J3d $ 33d ❑ ❑1IW2J3d 3HI SV S3Af3S NOILVOIlddV SIHl oN seA S31ON NO1103dSNI lf/NI3 AlNO 3Sf1 2:10103dSNI HOd 30Vd SIH1 S31ON NO1103dSNI SVO HOfOH