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HomeMy WebLinkAboutBLDG-22-006494 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rrs CITY YARMOUTH MA DATE May 11,2022 PERMIT# BLDG-22-006494 JOBSITE ADDRESS 7 BENNETT AVE OWNERS NAME RENAUD THOMAS H G OWNER ADDRESS RENAUD SUSAN M 235 PUTNAM HILL RD SUTTON MA 01590 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL©' PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES El NO El 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 • FIREPLACE FRYOLATOR • FURNACE GENERATOR 1 _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 El NO 0 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 Cameron Natale LICENSE# 4600 SIGNATURE MP 0 MGF©JP 0 JGF❑ LPGI El CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: Robies ADDRESS. 279 Yarmouth Rd. CITY Hyannis STATE MA ZIP 02601 TEL 5087753083 FAX CELL EMAIL S310N M3IA31:1 NVld #11W2J3d $ :333 ❑ ❑ iJI1213d 3H1 Sb S3AH3S N011V3 lddd SIHl oN saA S310N N01103dSNI 1VNId KINO 3Sf H0103dSNI 2J0d 3OVd SIH1 S310N NOI103dSNI SVO HJl02i