Loading...
HomeMy WebLinkAboutBLDG-23-000922 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r CITY YARMOUTH MA DATE August 22,2022 PERMIT# BLDG-23-000922 Yt:,SS3 JOBSITE ADDRESS 15 HEATHER LN OWNER'S NAME GOODWIN BARBARA J G OWNER ADDRESS CIO BRETT GOODWIN 36 GETTY CIR FAIRFIELD CT 06824 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 1 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 0 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 Matthew Scioletti LICENSE# MA SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Scioletti Plumbing and Heating ADDRESS. 58,townhouse ter,townhouse ter, CITY hyannis STATE MA ZIP 02601 TEL 7748100292 FAX CELL 7748100292 EMAIL S31ON M3IA3H NVId #iIWN3d $:333 ❑ ❑ 111/N3d 3H1 SV S3AH3S NOI1V3IlddV SIH1 oN saA S310N NO1103dSNI IVNIH .LINO 3Sf1 N0103dSNI NOd 30Vd SIHI S31ON N01133dSNI SV0 H9f1021