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HomeMy WebLinkAboutBLDG-22-003144 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kgCITY YARMOUTH MA DATE December02,2021 PERMIT# BLDG-22-003144 JOBSITE ADDRESS 118 COVE VIEW DR I OWNER'S NAME IKENNEDY REGINA G _ G OWNER ADDRESS 18 COVEVIEW DR SOUTH YARMOUTH MA 02664-2344 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ID RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 FIREPLACE FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 OWNERS 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 hereby certify that all of the details and information 1 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 andrew levesque LICENSE E Massachusetts SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑s COMPANY NAME: harwich port heating and cooling ADDRESS. 461 LOWER COUNTY ROAD, CITY Harwich Port STATE MA 1 ZIP 02646 TEL 5084323959 FAX CELL EMAIL S31ON M3 A3N NVlld #111A1b3d $ : 33 ❑ ❑ 111163d 3H1 SV S3A213S NOLLV011ddd SIHI oN so), S310N NO1103dSNI IVNIJ AlNO 3Sf1 J0103dSNI HOd JOYd SIH1 S310N NOI103dSNI SVO HOl0Zi