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HomeMy WebLinkAboutBLDG-22-007329 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ CITY rYARMOUTH MA DATE 'June 21,2022 I PERMIT# BLDG-22-007329 JOBSITE ADDRESS 27 GRANDVIEW DR OWNERS NAME Peter Quinlan G OWNER ADDRESS 27 GRANDVIEW DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL 0 PRINT CLEARLY NEW ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER - - CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 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 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❑ 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 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 r checkoway LICENSE# 13417 I SIGNATURE MP©MGF❑JP❑ JGF❑ LPGI❑ CORPORATION❑# J PARTNERSHIP ❑# LLC❑# COMPANY NAME CHECKOWAY ENTERPRISES ADDRESS. 11 scams hill rd.11 SCARGO HILL RD CITY DENNIS STATE MA ZIP 02638 TEL 5083851911 FAX CELL EMAIL checkentWcomcasl.net -.r S31ON M3IA38 N`dld #iIIN2i3d $ 33d ❑ ❑ 111183d 3H1 SV S3Ab3S NOI1v011ddv SIHL oN seA S310N NOI103dSNI 1VNId AlNO 3Sf1 b0103dSNI elOd 3OVd SIHI S31ON NOI103dSNI SVO H9f102i s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _4-an= "V CITY [SOUTH YARMOUTH MA DATE 6/17/22 PERMIT # 73 Z `� • ti JOBSITE ADDRESS 27 GRANDVIEW DR, S Y OWNER'S NAME PETER QUINLAN �T OWNER ADDRESS f 66 POOR ST, ANDOVER 01810 TEL'1978-807-6798 FAXf _ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: . REPLACEMENT: PLANS SUBMITTED: YES ' NO ;1 APPLIANCES 7 FLOORS—i BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER �'— BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER !— DRYER FIREPLACE 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 ! '� INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU 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 tI I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to t b 'st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P in provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE # 13417 ATURE MP MGF Ej JP JGF LPGI CORPORATION j# PARTNERSHIP{ # LLC #E.-___..__-__ COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE MA ZIP 02638 iTEL[ 98-385-1911 FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net