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HomeMy WebLinkAboutBLDG-19-000195 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 3;11_o CITY Yarmouth MA DATE 07/09/18 PERMIT#P1-46-W-007 A'�( JOBSITE ADDRESS 218 Winslow Gray OWNER'S NAME Laelzio Mosca GOWNER ADDRESS 218 Winslow Gray TEl1 /FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 9 RESIDENTIAL Q PRINT CLEARLY NEW:9 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO0 APPLIANCES 1 FLOORS—, 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER oil CONVERSION BURNER , COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT PON 11111111 POOL HEATER ROOM ISPACE HEATER ROOF TOP UNIT T T UT EATERR 5rWS Minn P UNVENTEDMUniiilla ROOM HEATER ER HEATER Enna MI OTHER r ' IMRE r la es 11111.11.15 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 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. 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 - - • my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in•.••-. _ .n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva LICENSE 11 31395-J ATURE MP 9 MGF 9 JP 0 JGF❑ LPG/❑ CORPORATION❑# PARTNERSHIP❑# 1 LLC❑# COMPANY NAME Silva Plumbing&Heating ADDRESS 155 Sudbury Lane CITY Hyannis STATE MA 2IPI02601 /TEL FAX CELLI774-836-0176 EMAIL virgiliomga©hotmail.com JUL 09 2018 I UR ft BUU IN PARTMt iT — • i P gQ/02. 7/6/ 40 -�