Loading...
HomeMy WebLinkAboutBLDG-23-000636 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE 'August 08,2022 'PERMIT# BLDG-23-000636 JOBSITE ADDRESS 21 GUNWALE WAY OWNER'S NAME VANETTEN ANN M G OWNER ADDRESS 75 BAY ST BRONX NY 10464 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO 111 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 © 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 at 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 ANDREW levesque LICENSE# 15162 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: harwich pod heating and cooling ADDRESS. 461 lower county road, CITY harwich port STATE MA ZIP 02668 TEL 5084323959 FAX CELL EMAIL S310N M3IA321 N`dld #11W2i3d $:33d ❑ El 1IV d 3H1 SV S3A2J3S NOI1V3lldd`d SIHI oN saA S310N N01103dSNI 1VNId AINO 3Sfl 10103dSNI 210d 39Vd SIH1 S310N NOI103dSNI S` O H9flOH