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HomeMy WebLinkAboutBLDG-22-004360 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 07,2022 PERMIT# BLDG-22-004360 JOBSITE ADDRESS 24 WILFIN RD j OWNERS NAME CASSIDY JASON S G OWNER ADDRESS CASSIDY MARIA A 161 SPRINGFIELD AVE STATEN ISLAND NY 10341 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ 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 1 • 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER OF INDEMNITY El 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 John Hesketh LICENSE# 13575 SIGNATURE MP©MOP 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC❑# COMPANY NAME: Capeway Plumbing&Heating ADDRESS. 75 Janebar Circle, CITY PLYMOUTH STATE MA ZIP 02360 TEL 5088883882 FAX CELL 5087890570 EMAIL S310N M3IA32i NVId #lIW2J3d $ :33d ❑ ❑ IIIJ d 3H1 SV S3/183S NOIiVOIlddV SIHI oN saA SRION NO103dSNI 1VNId AlN0 3Sfl 80103dSNI H03 3OVd SIHI S310N N01103dSNI SVJ HJl0b