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HomeMy WebLinkAboutBLDG-22-007187 Y -- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • BLDG-22-007187 �'.' ' CITY YARMOUTH MA DATE June 13,2022 PERMIT# • JOBSITE ADDRESS 6 DEVEAU LN OWNER'S NAME Stefanie Fox G OWNER ADDRESS 6 DEVEAU LN YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 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 DIRECT VENT HEATER DRYER 1 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 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 0 OTHER OF INDEMNITY 0 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 Vincent Marino LICENSE# 15136 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPG! ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: BEST YET INSTALLATIONS INC ADDRESS. 10 Meadow Rd, CITY Spencer STATE MA ZIP 01562 TEL 5088852378 FAX CELL EMAIL permitsebestyetinstallations.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES 4, .0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK A *cot.. CITY Vc,Oryvioo.Vii MA DATE 4 l Le cRQ_ PERMIT# JOBSITE ADDRESS De,1J'QC. 0 41 . OWNER'S NAME 5-C,. -CAY , '5b( GOWNER ADDRESS 5 amp TEL( c '514' OC I 1 FAX TYPE OR ^OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY /J NEW.; RENOVATION:_ REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 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 f�_.. a , _ _ a. � _ ;- _ _- -_- 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ;V NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW sU LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY BOND I 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 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 e ' ent/fr provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. g/ ____, PLUMBER-GASFITTER NAME V,0 ce\- Rlout no LICENSE# 1513(t SIG TURE MP v MGF JP JGF LPG' CORPORATION:v/# '�I S3 G PARTNERSHIP - # LLC # COMPANY NAME:?e5-1- Ve, - Tn siG III-ptL10S ..1-no.ADDRESS CITY ,. ... - etn ceX STATE lAn ZIP ois-c,c3 TEL FAX J3S-a CELL EMAIL