Loading...
HomeMy WebLinkAboutBLDG-23-004788 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK w= CITY YARMOUTH MA DATE March 01,2023 PERMIT# BLDG-23-004788 JOBSITE ADDRESS 418 ROUTE 6A OWNER'S NAME KUHFAHL SANDRA J G OWNER ADDRESS 418 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES El NO❑ FIXTURES FLOORS-c BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 0 OTHER OF INDEMNITY BOND El 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# 308 SIGNATURE MP❑MGF❑JP 0 JGF❑ LPG! ❑ CORPORATION❑#L PARTNERSHIP ❑# LLC❑#_ COMPANY NAME SEASIDE GAS SERVICE INC ADDRESS. 67 Helmsman Dr. CITY Yarmouth Port STATE MA ZIP L2675 _I TEL 5087712768 FAX CELL 5084000943 EMAIL S310N M31A32I NV1d #IIW213d $ :33d ❑ ❑ 1I1(213d 3H1 SV S3A2i3S NOIlV011ddd SIHl oN saA S310N NOI103dSNI 111NLI AINO 3Sf1 b0103dSNI NOd 39Vd SIH1 S310N NOI103dSNI SVO HOl02i