Loading...
HomeMy WebLinkAboutBLDG-23-006043 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK j CITY YARMOUTH MA DATE May 03,2023 PERMIT# BLDP-23-006043 JOBSITE ADDRESS 49 VACATION LN OWNER'S NAME CIULLA ANTHONY J G OWNER ADDRESS CIULLA MARGARET N 8 CAIN AVE BRAINTREE 021840000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© 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 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 © OTHER OF INDEMNITY El 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. PLUMBER-GASFITTER NAME Richard McGrath LICENSE# 13282 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC El# COMPANY NAME: ARS BOSTON ADDRESS. 300 Manley St., CITY West Bridgewater STATE MA ZIP 023790001 TEL 5085889025 FAX CELL EMAIL 8577permits anars.com s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -€"„ 1 MA DATE 13/16/23 PERMIT#BC,�& 23-00b0'0 _- CITY West Yarmouth JOBSITE ADDRESS 49 Vacation Lane 'Tony Ciulla OWNER'S NAME ;Tony I G OWNER ADDRESS 149 Vacation Lane 1 TEI.7-81..664.7088 ]FAX _ ._I TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL ,'1 RESIDENTIAL, CLEARLY NEW:r- PLANS SUBMITTED: YES[ RENOVATION:'.,,,,1 REPLACEMENT:Lid rj NO-,,,,,'„1 APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ; WU if BOOSTER _ _ .___ MN Ma CONVERSION BURNER 'INN NMI OM COOK STOVE MIN � � �� DIRECT VENT HEATER r l NMI 11MR MIN DRYER -"" FIREPLACE 1J � �NM NMI FRYOLATOR -' - l6 ,. 7 1 FURNACE r - ii 1f. ___ 1-- j .� ,- _ 1. .. I� _ E GENERATOR I WIN GRILLE ,T ��aa f ° . ' i. . .,.I ._..... .,__. . INFRARED HEATER . Y"� . s.. iT _v ® C,.. LABORATORY COCKS I . '' 1 _i.. :. __ iMiiiii MAKEUP AIR UNIT .r`1._.• L a o unnuni OVEN I� `iIli POOL HEATER 1 ., .. . 11 - ril- ali is'r'a s it TEST J . t w �-1,L, A. _ . - UNIT HEATER r R a -'1 �R MRMIt14114111 I UNVENTED ROOM HEATER L - I. :- F-B YULIEMENIKII $ WATER HEATER __mr__ 1 OTHER ' 9I. 'MIN IMO ON � 1_ i IIII u_.. _fin. . ..._ Y, _,.� 4 � 111 , - - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY r...# 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: s' R 0 AGENT Ej SIGNATURE OF OWNER OR AGENT /� I hereby certify that all of the details and information I have submitted or entered regarding this application are tru a : accurate t'•the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comdli- ce with all C-rtine :': ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Richard McGrath LICENSE#' 13282 j SIGNATURE MP L MGF Li-,1 JP Li JGF[J LPG'[J CORPORATION Ej# 4542-PLC si PARTNERSHIP(# - L I LLC LPL _... J COMPANY NAME: ARS/Heatin &A/C Services J ADDRESS 300 Manle St - __. CITY LW.Bridgewater __ — — — �� 9025 -- ---I � STATE MA ZIP 02379 TEL 508-588- FAX 508-583-7806 II CELLI 508-631-0515 IEMAILI 8577permits@ars.com -