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HomeMy WebLinkAboutBLDG-23-000756 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY [YARMOUTH I MA DATE 'August 15,2022 IPERMIT# BLDG-23-000756 JOBSITE ADDRESS 186 CRANBERRY LN OWNER'S NAME BURKE LUCY L TRS G OWNER ADDRESS THE CRANBERRY COVE TRUST 5 TIMBER LANE APT 304 EXETER NH 03833 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL D PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES Q 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 FRYOLATOR FURNACE 1 GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 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 0 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 Kevin Saunders LICENSE# 308 SIGNATURE MP 0 MGF❑JP❑ JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME SEASIDE GAS SERVICE INC ADDRESS_ 67 Helmsman Dr, CITY Yarmouth Port STATE MA ZIP 02675 TEL 5087712768 FAX CELL 5084000943 EMAIL S310N M3I/132I NVId #iJV d $:33d ❑ 0 110183d 3H1 SV SRAH3S NOI1VOIlddV SIHI oN saA S310N NOI103dSNI IVNId AlN0 3Sf12:10103dSNI 21Od 30Vd SIHJ S310N NOI103dSNI SVO HJl02i