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Home My WebLink AboutBLDG-23-000722 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t ' YA �. �� CITY RMOUTH _ MA DATE August 11,2022 PERMIT# BLDG-23-000722 _ JOBSITE ADDRESS 40 TROWBRIDGE PATH OWNER'S NAME EMMEL ERIC F G OWNER ADDRESS EMMEL BETHANY A 40 TROWBRIDGE PATH WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 1 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSJRANCE POLICY ❑ OTHER OF INDEMNITYLI 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 Ryan Latour LICENSE# 16991 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd. CITY STATE ZIP TEL FAX ]CELL EMAIL permitsabestyetinstallations.com S310N M3IA323 NVId #111A2f3d $ 33d ❑ ❑ iII1 3d 3H1 SV S3AH S NOI1V31lddV SIH1 oN saA S310N NO1103dSNI IVNId AlNO 3Sfl a0103dSNI 2102 3OVd SIHi S310N NO1133dSN1 SVO HOflOH Z. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _sue 12 CITY k). \416140041/) MA DATE .1 PERMIT# z JOBSITE ADDRESS 140 1'Y )5Y:4 eat i?G-' OWNER'S NAME .CW.O\ GOWNER ADDRESS ct 1 e, J TEL • 3 S3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[� PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:[ PLANS SUBMITTED: YES ❑ NO[JJ APPLIANCES 7 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 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 Ef NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d 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 Er AGENT ❑ 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 compile - -th all P�rtinen faro sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. l J , .I PLUMBER-GASFITTER NAME"RI C\X\ L G1-1•OU br LICENSE#/(0 6/q/ /4 01 SIG •JRE MP[j MGF❑ JP❑ JGF 0 LPG! ❑ CORPORATION i#N 15 3 C PARTNERSHIP❑# LLC❑# COMPANY NAME b 'IL-4- C1-1f`O1 S ir1C. ADDRESS it) e 17,1 . CITY SQ e,in c Y STATE 1,./1<I ZIP ()I S(oa TEL SO$-%%S•a 33-t x 1 FAX -c?.3 4 CELL EMAIL etani}S cvbe.5-I•ue.+inS-i-4114-kbh5• CUvn 'w_.