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Home My WebLink AboutBLDG-23-006001 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 11/4 CITY IYARMOUTH MA DATE May 01,2023 PERMIT# BLDG-23-006001 I r_ '.0 JOBSITE ADDRESS 8 DANBURY ST OWNER'S NAME LEARY EDWIN M G OWNER ADDRESS LEARY ELIZABETH 46 SO LIBERTY ST BELCHERTOWN MA 01007 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL III PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ 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 ' 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 El 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 (Christopher Salva LICENSE# 15800 SIGNATURE MP El MGF El JP❑ JGF❑ LPG! El CORPORATION El# PARTNERSHIP El# LLC ❑# COMPANY NAME: ICHRISTOPHER SALVA ADDRESS. 1200 OLD BELCHERTOWN RD, CITY IWARE STATE MA ZIP 010829441 TEL I FAX CELL EMAIL chris[7a ctsplumbina.com Rrl MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �''- Citr r-So 4_41 liar vy,rsr ----I MA DATER,‘ao,“ I PERMIT#Sac - z 3- roewi JOBSITE ADDRESS ?j ? Jeaht-iticf _-- j . T. G Y' S� �OWNER'S NAME �G/L.2 OWNER ADDRESS TYPE OR 4c .. Eli A �( 6/.'? FAX �� PRINT OCCUPANCY TYPE COMMERCIAL s EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION:i. REPLACEMENT:Li PLANS SUBMITTED: YES r71 re I NO BOILERAPPLIANCES 1 FLOORS-► BSM 1 2 3 4 5 6 7 8 9 10 11 J 12 1 13 14 MS1,._ BOOS i - -- - - CO 'a BURNER NOM MI COOK STQ1�E - ��° Mil DIREC VENT HEATER in WU MR MI �a a'— 3 DRYER FIREPLACE lea MI FRYOLATOR - FURNACE , GENERATOR > GRILLE INFRARED HEATER t s ��IMF OM ` OM SIMS MS OM MK LABORATORY COCKS Nit ea NM NW OM Mt 1.111111111 MN MOM MNMAKEUP AIR UNIT ' OVEN __ POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER OM MI NIFITM AM IMIIIMIIIII INN MI 111111W1 MP MR UNVENTED ROOM HEATER leer - WATER HEATER_ _ 111111 MI Ili ,NM MI 1111.111 MI NM IMF MI NMI MN MIN I OTHER - Mg iiii alli MI MO MI OM MK MN MN MR MI WOW NMI am intim itaisitimatio isetait an iimani temiait ainimil ivy=win=ano t gig am ow MN MI al NMI OM MIN 111111111-111 MI NM MIMI AM*MUM Mil INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Ej NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 7, OTHER TYPE INDEMNITY BOND L. OWNER'S INSURANCE WAIVER:lam 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 CHECK ONE ONLY: OWNER Ot AGENT L 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 Massachusetts State Plumbing Code and Chapter 142 of the General Laws, will be in complia h Went provision of the PLIA*ER-GASFITTER NAME Chfls Salva t LICENSE# 15800 / SIGNATURE MP + MGF JP{ 1 JGF LPGI CORPORATION �#i4491 PARTNERSHIP # LLC # - COMPANY NAME:CTS Plumbing&Heating CO ADDRESS 200 Old Belchertown Rd T�T - _ CITY Ware - r �_�t I STATE r MA I ZIP i01082 TEL?413-230-9705 FAX , CELL yEMAILChtisic�ctsplumbing.com �~