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HomeMy WebLinkAboutBLDG-23-004798 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE March 01,2023 PERMIT# BLDG-23-004798 JOBSITE ADDRESS 60 BEVERLY RD OWNER'S NAME MASSA STEPHEN A TRS G OWNER ADDRESS MASSA ROBERT F TRS 22 HILLCREST RD WESTON MA 02493 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 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 I SPACE HEATER 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 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 Virgilio Silva LICENSE# 31395 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomgaahotmail.com z. MASSA H TT UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK C USE S 1r =AI � —_"" -Mot—y" CITY Yarmouth MA DATE 03/01/23 PERMIT# i JOBSITE ADDRESS 30 Beverly Rd. OWNER'S NAME Stephen Massa GOWNER ADDRESS 60 Beverly Rd. TEU978-857-5797 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL El RESIDENTIAL ID PRINT CLEARLY NEW:[J RENOVATION:El REPLACEMENT:[J PLANS SUBMITTED: YES El NO LI APPLIANCES 1 FLOORS BSM 1 2. 'I 3 _4 5 ; ms 7_ � 8 ' 9 10 11 12 13 14 BOILER _ril BOOSTER 1 CONVERSION BURNER . COOK STOVF DIREC litNeletTle I V E 1 __ DRYS -- [` ., i FIREP C= 'i3 m l I 1 ._. .I_ 1 FRYO TQR MAR O 1 GENE �UFURN E__ -i/(, 1 .1. F"ARl-MENT _ . _. _ _ . - GRILL aY._ INFRARED HEATER _ ,- 1 I 1 LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER 11 ,r_ 1 ; ROOF TOP UNIT 1 Y "I I TEST I UNIT HEATER UNVENTED ROOM HEATER o _ 1 I 1 WATER HEATER 1 ' I OTHER �_ 1- �_ I w INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY Ei BOND El 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 ED 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 ac the b knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli with all Pertinent provision f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J SIGNATURE MP El MGF ED JP 0 JGF El LPGI El CORPORATION #✓ PARTNERSHIP D# LLC # COMPANY NAMESilva Plumbing&Heating INC. ADDRESS 155 Sudbury Lane CITY Hyannis STATE MA ZIP J2601 TEL _h FAX - CELL EMAIL EMAIL virgiliomga@hotmail.com