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HomeMy WebLinkAboutBLDG-23-000694 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YYARMOUTH MA DATE !August 10,2022 PERMIT# BLDG-23-000694 JOBSITE ADDRESS 112 BURCH RD OWNERS NAME ITIGHE ROBERT J TR G OWNER ADDRESS 112 BURCH RD SOUTH YARMOUTH MA 02664 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL PST ❑ RESIDENTIAL ID CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS---. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE 2 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN • POOL HEATER • ROOM/SPACE HEATER ROOFTOP UNIT TEST 1 • UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 0 OTHER OF INDEMNITY El 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 (Brian Ricci 'LICENSE# 126181 I SIGNATURE MP❑ MGF 0 JP© JGF❑ LPGI ❑ CORPORATION 0#! I PARTNERSHIP 0#I ILLC 0# I COMPANY NAME: IBRIAN RICCI ADDRESS. 18 ROCKMEADOW DR, CITY IE BRIDGEWTR I STATE IMA I ZIP 1023332433 I TEL FAX 1 1 CELL 1 1 EMAIL ricciplumbinq(a7yahoo.com iittiwg,_cirgq: ia - 0 gt is-6-0 4f ids a - — '- 7 I V , t: NLISETTS UNIFORM APPUCATION FOR A - -, - -,---- -1 ORM GAS FITTING WORK ,4....., 1/ CITY- ; MA DATE if'./st-942 PERMIT 4*2.3-- - 0 202 II n "t' kE JOSS! •a 1;ESS ix h,utkeki 1:?p, OWNER'S NM& ,5c20-;7 4.1411_1914 Fill ilign‘,44K BU-IEG D E P 8 0 i g - Ta (j7 3Ify° FAX TYPE°11 EDUCATIONAL RESIDENTIAL frj $ OCCUPANCY TYPE COM1012RCIAL E3 Ej _ • ' CLEARLY NEW-.lit1 RENOVATION:E3 REPLACE1AENT:E:i PLANS SUBMiTTEI): YES Ej NO 'L Z1 i) APPLIANCES 1 FLOORS-4 I dat 1 1 2 I._ 3 4 I 5 I 6 I 7 I 8 9 V i1 1 12 i ;i3 1 i4 , BOILER 0 - : • - 1 - ' 0' i - • I BOOSTER ..' 1 _ - - - - - 1 - CONVERSION BURNER • - c... COOK STOVE I ',, ' . . \, ; ' r - - DIRECT VENT WATER DRYER _ • , - • ' FIREPLACE _ - 1 ' ' - ' • •- . „ ' -- FRYOLATOR - - .• FURNACE _ 1 - - c... - - /GENERATOR ' - - • ',.., ' ' c i .GRILLE . 1 ' C ;.; ... ----1 ' -• * - *FRAM!)HEATER , ,, 0 10 LABORATORY COCKS ; -— ,, • ,c r - - -• N ' - MAKEIP AIR UNIT _ _, _ 1 , _ , t _ , , , _ _. 0 _. .. „ OVEN . _i . ; •- ' ,, •- .,, POOL!EATER ,; ' • - ;Iv • . - .• ROOM/SPACE HEATER ROOF TOP UNIT 0 .„, ______ ' ' ,, . , . . 1 TEST . ,, ' UtilT lEATER 1 UNVBITED ROOM HEATER 01 I WATER 114fAlipill . _1 _ v . . _ _ . actER ‘ ' - - INSURANCE COVERAGE I have a current liablitv insurance policy or Its substandal equivalent which meets the requirements of MGL Ch.442 YES !..:1 t40 0 IF YOU CtECIUM YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THEAPPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Dg) OTHER TYPE IND914M` E j BOND C] • OWNERS INSURANCE WAIVER:I ion aware that the licensee does not have the insurance coverage required by Chapter 142 of the Aliresecinseetts General Laws,end that my signature on this permit application%valves this requirement. CHECK ONE ONLY: OWNER :3 AGENT 0 • SIGNATURE OF OWNER OR AGENT thereby certify that al tithe details and ktformation I have submitted or entered regarding itas appecadon we true and accurate to the best of my knovAedge • and that all plumbktg work and tetediedonts perfomvad under dte pernilt issued for this.application wM be kt-.,. . with WI P provitAort of the Massadiusetts State Plumbing Code and Chapter 142 d the General Laws. , "` 1 _. , ara PLINBER-GASFITTER NAME113g,lAA( iiier4 1 LICENSE Magri I ir ZTURE M'EZI MGF C] JP 18-41 JGF[3 LPG,E]. CORPORATION Ejd I. I PARTNERSHIP pep I LLC Di,' .._I O COAFANY NAMEigica..41*jaafrez.,..ceichrtzitesi ADDRESS le Rorsic 1,4itiroid fA. _ I CITY i6sr....Agto4tg4ra _ _j STATE VgijaP44113ITI1 t1472e-..,2.7.0z0_____1 FAX I 1 CELL, si 1,trit 5i17-1EmAL -