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HomeMy WebLinkAboutBLDG-22-003320 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 10,202'PERMIT# BLDG-22-003320 f JOBSITE ADDRESS 9 MARINERS LN OWNERS NAME LENTOL CYNTHIA LAUREL TR G OWNER ADDRESS C/0 WETZEL STANLEE 9 MARINERS LN YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT❑ 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 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 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 'CHRISTOPHER BRIGGS I LICENSE MA SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: IBriggs&Heino I ADDRESS. 136 ROLLING HITCH RD, CITY ICENTERVILLE ISTATE MA ZIP 02632 TEL 5087880816 FAX I CELL I I EMAIL I S310N M3IA32:1 NVld #IIV d $ :33d ❑ ❑ 1IW83d 3H1 SV S3AH3S NOLLVOIlddd SIHJ ON SeA S31ON NO1103dSNI 1VNId AINO 3Sfl 2d0103dSNI 2:1Od JOVd SIHI S310N NOI103dSNI St/9 HOfOb