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HomeMy WebLinkAboutBLDG-23-004802 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I MA DATE IMarch 01,2023 I PERMIT# BLDG-23-004802 '� �� CITY 'YARMOUTH JOBSITE ADDRESS I8 CAPT PERCIVAL RD I OWNERS NAME IMANZELLI MARJORIE E(LIFE EST) G OWNER ADDRESS 18 CAPT.PERCIVAL RD SOUTH YARMOUTH 026640000 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL al PRINT PLANS SUBMITTED:YES CI NO CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT: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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/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 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 'William Holmes LICENSE# 14592 I SIGNATURE MP❑ MGF © JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IRCA ELECTRICAL CONTRACTORS I ADDRESS. 19 Hunters Trail, CITY (Sandwich STATE MA ZIP 025632701 TEL '5084280449 FAX CELL I I EMAIL Iellenta7.rcaelectric.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK T. > ,,...,.... '� T y 03 - D� �.psi=> CITY Yarmouth MA DATE 2/23/23 PERMIT# JOBSITE ADDRESS 18 Captain Percival Road OWNER'S NAME Marjorie Manzelli GOWNER ADDRESS 5 same TEL;508-760-4595 FAX TYPE PRINTR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW:L i i RENOVATION: REPLACEMENT:„ PLANS SUBMITTED: YES ' NO„i, APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER 3r CONVERSION BURNER NMI IIIRIIIIIIMIIIIIIEIIIIBIIIIIII MM.;" ' COOK STOVE DIRECT VENT HEATER DRYER NM II.1J FIREPLACE --1 — � FRYOLATOR .• I matinswie I ... , FURNACE . �� GENERATOR ` _ . GRILLE ,�,' INFRARED HE 1 �� [ mm u t: I MAKEUP AIR U ..� ;I 55 LABORATORY • P , .. - 1.1 I OVEN MiliditilMilin NMI JIIIIIIIIMfIti _A POOL HEATER • m 1 ROOM/SPAC:14PATPR— f ROOF TOP UNIT r TEST 1 ; UNIT,-HEATER ,- - _. UNV, NTED ROOM HEATER W ER HEATER OTHER _� MEM INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES /5±I NO ,_ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ! OTHER TYPE INDEMNITY BOND 1 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 appl atio re true a cur to e best of my knowledge and that all plumbing work and installations performed under the permit issued for this application I i co ian ith e ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME'William B.Holmes E LICENSE# 4592-M IGNATURE MP r MGF_A -I-1 JP JGF ° LPGI CORPORATION i #I 043585106 PARTNERSHIP , #, LLC I# COMPANY NAME RCA Electrical Contractors Inc. ADDRESS 153 Commercial St. CITY Mash pee ��� � STATE MA ZIP;02649 TEL y 508-428 0449 � ? FAX' CELL EMAIL ellen@arcaelectric.com