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Home My WebLink AboutBLDG-22-003238 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 07,2021 PERMIT# BLDG-22-003238 JOBSITE ADDRESS 50 GROUSE LN OWNERS NAME Mark Haynes G OWNER ADDRESS 50 GROUSE LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ 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 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 0 IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El 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 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME David Casey LICENSE E 25206 SIGNATURE MP❑MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION 0# PARTNERSHIP El# LLC❑# COMPANY NAME: DAVID E CASEY ADDRESS. 11 HUNTERS TRL, CITY 'SANDWICH I STATE MA ZIP 025632701 TEL FAX CELL EMAIL capecomfortsystemsp(�,omail.com S3ION M31A3H Ndld #II J fld $ 33d ❑ ❑ 11W213d 3H1 SV S3Aa3S NOI1VO lddd SIHl oN seA S310N NO1103dSNI-ANN AINO JSII HO1.03dSNI 2:1Od 30Vd SIH1 S310N NOIl03dSNl SYJ Ronal MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK E 1= CITY:\L c r p e/11C U't•}• MA. DATE: // ' /th L I PERMIT# ZZ — 3 Z 3 JOBSITE ADDRESS: 50 �-7--gc(i )--ThV OWNER'S NAME: /97A':M-1'C ! V E D GOWNER ADDRESS: 1:0Edgb(t . 6-4 N TEL: 6 UC: ---- —_ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAr DEC 07 2021 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUM BUIl DING _PATri RAF APPLIANCES FLOOR-. Bsmt 1 2 3 4 5 6 7 8 9 10 "C1- 12 1, i'4--• BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE '✓ GENERATOR tit GRILLE vl INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE I-EATER J ROOF TOP UNIT ' TEST .3- UNIT HEATER .0 UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ci NO El If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE 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 CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 com Hance with all Pertin nt provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. i - 1 - PLUMBER/GASFITrERNAME: Vf vl i? C (,ASS y LICENSE#6?,5; l SIGNATURE COMPANY NAME:_ !_/ L`" le Pe„G/ 5. ,;7II ADDRESS: Pe/ 56.k. z&; CITY: LI� �! { STATE:jYJ ZIP: l ) c' 11 FAX: TEL: 50: ' a&AA Z 'CELL:fOS ' ('G' (J7-O.6 EMAIL: (' Ccrl F6 .fysi EI'1S cL jmq,/ k., n MASTER❑ JOURNEYMAN( LP INSTALLER❑ CORPORATION❑# PARTNERSHIP C1# LLC❑ C h2 f}i c. ZZ2&SS :