Loading...
HomeMy WebLinkAboutBLDG-22-003044 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e,kCITY YARMOUTH MA DATE November 24,2021 PERMIT# BLDG-22-003044 JOBSITE ADDRESS 21 LYNDALE RD OWNER'S NAME MARZANO LINDA M G OWNER ADDRESS 31 BEACH AVE HULL MA 02045-2701 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Ill PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 FIREPLACE FRYOLATOR FURNACE 1 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 ❑ OTHER OF 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. 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 (Virgilio Silva LICENSE# 31395 SIGNATURE MP 0 MGF ❑ JP© JGF 0 LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IVIRGILIO SILVA ADDRESS. 1155 SUDBURY LN, CITY IHYANNIS STATE MA ZIP 026012462 TEL 1 FAX CELL EMAIL Ivirgiliomga(a,hotmail.com 1 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , �. icy IF 5i*,. CITY ,armouth I MA DATE:11/24/21 I PERMIT# 2 Z- 3 ` h JOBSITE ADDRESS 121 Lindale Rd. 1 OWNER'S NAME (Linda Mariano GOWNER ADDRESS 121 Lindale Rd. TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL F-1 EDUCATIONAL I g RESIDENTIAL I I PRINT CLEARLY NEW:I _1 RENOVATION:Li REPLACEMENT:s'1 PLANS SUBMITTED: YES Li NO 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 } 1 ' t - FRYOLATOR i. _ a 6 , FURNACE 1 ,,all MI=__ i I O>"MI ;=11111111k1111111" GENERATOR j ' _ �� '' . .... .. GRILLE r — . INFRARED HEATER �1 1 . ; LABORATORY COCKS MAKEUP AIR UNIT OVEN l' ' 1 . . i �,_ i POOL HEATER j e ' , ROOM I SPACE HEATER Iin- _ _��f � 1' I— I 9. ROOF TOP UNIT - ms UNIT HEATER 1..e_s--1 --in—IL _._-i _' _.... 1 ,,. . ,._ UNVENTED ROOM HEATERr ,WATER 1 1 IIIIIIIIIIIII OTHER HEATER _-_.__._.,___�. ,1111111111111111111114610111111 � M , i IIIISPIMMIONINIIIMINIF r . IMO iIIIIIIHM1111111111111111111211111111111;111111111101111111111111 is if !i 1 i,l INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I °I NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ['j OTHER TYPE INDEMNITY 1 j BOND I 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 4. 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 • - -e nent provisio • .e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - PLUMBER-GASFITTER NAME;Virgilio Silva I LICENSE#[31395-J I SIGN• •' " �--- MP r N j MGF Eli JP;--•-,1 JGF t- ] LPGI El CORPORATION Ell#l _ 3 PARTNERSHIP #;L - LLC L.....,0 L_____ 1 I ADDRESS y 155 Sudbury Lane ,__ �,.�._....�- I COMPANY NAME:"Silva Plumbing&Heating 41; �_. ___ __..� X7.....4-a. ; *- e is` 3 �.____..___._ STATE MA 1ZIP102601 TEL;—i_=. CITY iHyannist - I FAX CELL 7748360176 1EMAILIvirgiliomga@hotmail.com NOV ?4 2021i 1 Lii