Loading...
HomeMy WebLinkAboutBLDG-22-000502 _r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 CITY YARMOUTH MA DATE July 27,2021 PERMIT# BLDG-22-000502 JOBSITE ADDRESS 82 POINSETTIA DR OWNER'S NAME FILOSA PETER R TRS G OWNER ADDRESS THE POINSETTIA DR RLTY TR II 8 AGNES RD MILFORD MA 01757-1827 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO El 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 1 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 ❑ OTHER OF INDEMNITY❑ BOND 0 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 R Peter Checkoway LICENSE# 13417 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: checkoway enterprises ADDRESS. 11 scarpo hill rd, CITY DENNIS,MA 02638 STATE MA ZIP 02638 TEL FAX CELL EMAIL S310N M31M32J NVld #.IW2i3d $ 33d ❑ ❑ 1IW213d 3E11 SV S3AU S NOIlVOIlddV SIH1 oN saA S310N NO1103dSNI 1VNld AINO 3Sfl N0103dSNI LIOd 30Vd SIHl S310N N01103dSNI SVO HOfON