HomeMy WebLinkAboutBLDG-22-002587 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
�— CITY 'YARMOUTH MA DATE 'November 04,202''PERMIT# BLDG-22-002587
` JOBSITE ADDRESS 27&29 COURTLAND WAY OWNER'S NAME MUIR MICHAEL TR
G OWNER ADDRESS J&S CAPE RLTY TRUST P 0 BOX 62 WEST BOYLSTON MA 01583 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL
PRINT
CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ 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
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 0 NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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 la 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 Stale Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Chris Briggs LICENSE# 12901 SIGNATURE
MP 0 MGF❑JP 0 JGF 0 LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑#
COMPANY NAME: Briggs&Heins ADDRESS. 36 ROLLING HITCH RD,
CITY CENTERVILLE STATE MA ZIP 02632 TEL
FAX CELL EMAIL
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