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HomeMy WebLinkAboutBLDG-23-004825 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 02,2023 PERMIT# BLDG-23-004825 JOBSITE ADDRESS 9 JEANNES PATH OWNERS NAME COOKE JOSEPH C V JR G OWNER ADDRESS 9 JEANNES PATH YARMOUTH PORT MA 02675-1914 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO FIXTURES FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 "2 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 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 Kevin Saunders LICENSE# 308 SIGNATURE MP❑MGF❑JP 0 JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: SEASIDE GAS SERVICE INC ADDRESS. 67 Helmsman Dr, CITY Yarmouth Port STATE En=ZIP 02675 TEL 5087712768 FAX CELL 5084000943 EMAIL S310N M3IA32i Ndld #JIW2i3d $ :33d El 0 ±I141?13d 3H1 SV S3A213S NOI1VOIlddV SIHl oN seA S31ON N0I103dSNI 1VNIJ AlNO 3Sfl H0103dSNI 2i0d 3DVd SIHJ SiLON N01103dSNI SVO HJl02i