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HomeMy WebLinkAboutBLDG-22-005505 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 711,--mr, CITY YARMOUTHI BLDG-22-005505 1„ MA DATE March 30,2022 PERMIT#JOBSITE ADDRESS L MAYFLOWER TERR OWNER'S NAME SCOTT DAVID A G OWNER ADDRESS 40 BONNIE BRIER CIR HINGHAM MA 02043 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ 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 1 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 ❑ 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 NAIVER: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 Sullivan LICENSE# 13041 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# _ PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [Ready Rooter,Inc. ADDRESS. P.O.Box 371, CITY Sandwich STATE MA ZIP 02563 TEL _5088886055 FAX CELL EMAIL S310N M3IA32:1 NVId #11Wa3d $ 33d ❑ ❑ 11Wa3d 3H1 SV SAS NOIlVOIlddV SIHI ON S8A S310N NO1103dSNI 1VNId AINO 3Sfl a0103dSNI aOd 30Vd SIH1 S31ON NO1103dSNI SV0 HOfOa