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Home My WebLink AboutBLDG-22-006983 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK q F i � r CITY 'YARMOUTH I MA DATE June 02,2022 PERMIT# BLDG-22-006983 JOBSITE ADDRESS 78 CURVE HILL RD OWNER'S NAME SNOWDEN SANDRA A G OWNER ADDRESS 78 CURVE HILL RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS-. BSM 1 2 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 ❑ 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 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 Vincent Marino LICENSE# 15136 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME BEST YET INSTALLATIONS INC , ADDRESS. 10 Meadow Rd, CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX ]CELL EMAIL permitsna.oestvetinstallations.com S3 LON M3IA3a NVId #11WN3d $:33d ❑ ❑ III MEd d 3E11 SV S3A83S NOI1V3IlddV SIH1 oN s9A S310N NO1133dSNI 1VNId AINO 3Sf1 210133dSNI 210d 30Vd SIHJ S310N N01103dSNI SVO HOl021 i-�'_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �: � �~-� �..�� MA DAT � ERMIT # 2 � (� 5 y CITE' JOB SITE ADDRESS F4T, C O V-V\ _, l\ , ._ ... .._- OWNER'S NAME t ,rC :,��;`'"� �. G OWNER ADDRESS �.L TEL (� a� .9 FAX =FAX ..__._. _.. r . __, TYPE OR OCCUPANCY TYPE COMMERCIAL -__. EDUCATIONAL r-p RESIDENTIAL J PRINT -_. CLEARLY NEB: RENOVATION: REPLACEMENT: / PLANS SUBMITTED: YES ' NOj APPLIANCES 1 FLOORS—I 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 1! GRILLE ram _ , INFRARED HEATER j_ . LABORATORY COCKS I MAKEUP AIR UNIT OVEN ir POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER 1 'i__ UNVENTED ROOM HEATER WATER HEATER OTHER w. �s m INSURANCE COVERAGE m I have a current Iiabilit _insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES EINO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW s . LIABILITY INSURANCE POLICY v OTHER TYPE INDEMNITY 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. CHECK ONE ONLY: OWNER , AGENT 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 wort and installations performed under the permit issued for this application will be in compliance with all PertVnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. IRCI , 1/1)4..4 , ,,4 •�PLUMBER-GASFITTER NAME , ce , 1,kotc:AnD_____ __ILICENSE #j\ i� �`V/ SIGNATURE MP v MGF D JP JGF Ej LPGEl CORPORATION ' ✓ # IS"3 d 1 PARTNERSHIP ,,_ i # _ _ LLC # COMPANY NAME: C.`>`� � `fi ...-a. S " iII.<,-,- _ 1i : ADDRESS ,,\J. _: t�'C)V' .� _-M CITYbpekr‘Ce,y" STATE ... ZI P,� 1 S� -G __,TEL '_�d 5 r . x 1 � �� N� �� ' `� ___' - _ _- - -'___ '-_.--__�____ __ - _ ___-__ - ~__- _ __--_ -- _ -�___�� ___~_' - __ _- __ _ -_ _ - _ ' _ - -__ -_ _ _- -_ --_ __ -___ _ _ - - � � .