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HomeMy WebLinkAboutBLDG-22-004335 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 03,2022 PERMIT# BLDG-22-004335 • JOBSITE ADDRESS 481 BUCK ISLAND RD UNIT 15EA OWNER'S NAME SKOLER EDWARD C TRS G OWNER ADDRESS SKOLER ELAINE S 481 BUCK ISLAND RD UNIT 15EA WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES ❑ NO FIXTURES FLOORS—I 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 1 OTHER DESCRIPTION:Install new tee on existing gas line in basement Run a new gas pipe to existing gas stove and connect 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 ❑ 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 Charles Markarian LICENSE# 9197 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# , PARTNERSHIP ❑# LLC ❑# COMPANY NAME: The Pipe Doctor ADDRESS. PO Box 2227, CITY Hyannis STATE MA ZIP 02601 TEL 5087756670 FAX CELL EMAIL S310N M3IAA NVId #JIWt13d $:33d ❑ ❑ 1IINa3d 3H1 SV S3Aa3S NOIlVoIlddV SIHI oN saA S310N NOI103dSNI IVNId AINO 3Sfl J10103dSNI 2IOd 30Vd SIHI SALON N01103dSNI SVO HOfO I