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Home My WebLink AboutBldg-22-002582 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY YARMOUTH MA DATE November 04,2021 PERMIT# BLDG-22-002582 tl JOBSITE ADDRESS 6 ALIJO DR OWNER'S NAME Diego Baveloni G OWNER ADDRESS 6 ALIJO DR WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES ❑ 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 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 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 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 IVirgilio Silva LICENSE# 131395 I SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPG! ❑ CORPORATION 0#( PARTNERSHIP 0# LLC ❑#I COMPANY NAME: VIRGILIO SILVA ADDRESS. 1155 SUDBURY LN, CITY IHYANNIS I STATE MA ZIP 1026012462 I TEL I FAX I I CELL 1 I EMAIL Ivirgiliomga(a,hotmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT GI FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK / s►i=y' CITY Yarmouth 7 MA DATE 11/04/21 PERMIT# ZZ- 2 S 8Z JOBSITE ADDRESS S Alijo Dr. OWNER'S NAME Diego Baveloni GOWNER ADDRESS 6 Alijo Dr. TEL5083602551 FAX, 1 TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO Q APPLIANCES Z FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I DRYER FIREPLACE FRYOLATOR FURNACE . . GENERATOR GRILLE INFRARED HEATER I I .. j__. ___ LABORATORY COCKS ma MAKEUP AIR UNIT I IIIIIIIIi2tUI POOL HEATER II finnEIZZIPIR. '�ROOM/SPACE HEATERlt' ROOF TOP UNIT Mg M MI Mil IIIIIII MIM;ME MIN MI MU TEST M 1MB ME M ' MIR NIBS NNE 1111111 UNIT HEATER wo UNVEN ED ROOM HEATERI, • i obi WATER HEATER ' ! OTHER ..,... _ m INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY El BOND LI 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 El AGENT El 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 w ertinent provisio the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J SIGNATURE MP El MGF ED JP El JGF® LPGI® CORPORATION®# PARTNERSHIP El# LLC El# COMPANY NAMESilva Plumbing&Heating ADDRESS 155 Sudbury Lane CITY Hyannis STATE MA ZIP 32601 TEL y FAX CELL7748360176 EMAIL virgiliomga@hotmail.com Cdf 073