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HomeMy WebLinkAboutBLDG-23-005538 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �„ E� CITY 'YARMOUTH ( MA DATE (April 05,2023 PERMIT# BLDG-23-005538 � Nr - '•y" JOBSITE ADDRESS 1452 ROUTE 28 OWNER'S NAME IT&C HOLDINGS LLC G OWNER ADDRESS 518 ROUTE 28 WEST YARMOUTH 02673-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL ❑ PRINT PLANS SUBMITTED: YES El NO CLEARLY NEW: ElRENOVATION:❑ REPLACEMENT:El _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 2 FIREPLACE • FRYOLATOR • FURNACE 1 • GENERATOR GRILLE INFRARED HEATER • LABORATORY COCKS • MAKEUP AIR UNIT • OVEN POOL HEATER 2 • ROOM 1 SPACE HEATER 1 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 BOND ❑ 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.Gremila LICENSE# 116066 I SIGNATURE Jonathan PLUMBER-GASFITTER NAMEPARTNERSHIP CI#I lac El#1 I MP© MGF 0 JP 0 JGF❑ LPGI El CORPORATION El# COMPANY NAME: JONATHAN GREMILA ADDRESS. 38 McGuertv Rd, STATE MA ZIP 026451506 TEL CITY FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,ram:w,, -:�, 9 ; CITY 'Yarmouth MA DATE 1104-04-2023 PE IT# JOBSITE ADDRESS°452 Main St OWNER'S NAME jTown and Country G r . #_OWNER ADDRESS ' 'TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL;.. EDUCATIONAL RESIDENTIAL y: PRINT .� CLEARLY NEW: . ., RENOVATION `—� REPLACEMENT: PLANS SUBMITTED: YES Ji NO; APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER L t r_ BOOSTER fi i ' CONVERSION BURNER i _ ' ry COOK STOVE r r- ,; 4- 3 DIRECT VENT HEATER r.. ,.. `, _ 4 .._- 1 `. _ x sa DRYER 2 = FIREPLACE t _ FRYOLATOR -" ,..-,.. .a .� . k ..ter. „'_.,..,. _ -+. _..._ FURNACE -1i GENERATOR ' _ GRILLE INFRARED HEATER - - LABORATORY COCKS ' � i MAKEUP AIR UNIT t 1 �i 4.; i - 5.do' —,t—__.,. R 4 7.° " _. Ate. .a..... k .. OVEN r 1 � 4 F 1 5 3. rk POOL HEATER ' �z 2 t ROOM I SPACE HEATER i 1 : tg 1 ROOF TOP UNIT TEST 1' i f . UNIT HEATER - /€ i= 1 i UNVENTED ROOM HEATER � L� s ^ • .max WATER HEATER ' OTHER r _ 3 ;'* �''� ' - � t_ k.v.y ..u'.,. � -5.'-""-'''.. rn't--...-,.`-...-- ."'"." ' a,. . � _ " — .>..�.. i_ „ �_ S 1,_„,,,,,,,,„,„,,,,_,,,. u w;sw.-.„N rv . xw,- &+o a _ pssr r =ls' § _ u .a a ua � x � �..�s+a sw -.a*,•L.5+ixnwa u.Y,ar.«e st : u.,5„ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES �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 L„_„ 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 ; ,j AGENT 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 compli 'th all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Jonathan Gremila LICENSE#116066 SIGNATURE MP , Mu' MGF , ., ? JP _.4. JGF p / LPG! CORPORATION' 1# 'PAR SHIP /# Y m LLC f, # COMPANY NAME:!JBG Plumbing&Heating INC ADDRESS 18 Daluze dr CITY Harwich; STATE; MA ZIP;02645 TEL 774-722-3928 FAX /CELL 'EMAIL!' remila ahoo.com