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HomeMy WebLinkAboutBLDG-23-001755 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ^,� CITY YARMOUTH MA DATE October 03,2022 PERMIT# BLDG-23-001755 JOBSITE ADDRESS 101 FAIRWOOD RD OWNER'S NAME Steven Lowell G OWNER ADDRESS 101 FAIRWOOD RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/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 0 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 Virgilio Silva LICENSE# 31395 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IVIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY IHYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL IvirgiliomgaRhotmail.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK IRS .r.."!l lid -G1 , CITY Yarmouth MA DATE 09/28/22 PERMIT# Z 3' I'IS- JOBSITE ADDRESS 101 Fairwood Rd. OWNER'S NAME Steven Lowell GOWNER ADDRESS 101 Fairwood Rd. TEL JFAX I TYPE OR OCCUPANCY TYPE COMMERCIAL E1 EDUCATIONAL PR ® RESIDENTIAL Ei CLEARLY NEW:Ej RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES] NOEl APPLIANCES 1. 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 1 1 � � DRYER FIREPLACE " _g ‘ 'I .�. 9- I 1 A ,I _ _ a FRYOLATOR �` FURNACE 1 a,''� GENERATOR GRILLE A . INFRARED HEATER I LABORATORY COCKS "� MAKEUP AIR UNIT �. . I_ I a 1 OVEN POOL HEATER , ROOM/SPACE HEATER m _ _ ai ROOF TOP UNIT , TEST � � � ,- UNIT HEATER I UNVENTED ROOM HEATER ' �I WATER HEATER p OTHER 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 [D OTHER TYPE INDEMNITY 0 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. CHECK ONE ONLY: OWNER ® AGENT 0 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 ' ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J — — MP El MGF D JP 0 JGF® LPGI® CORPORATION®# 1 PARTNERSHIP[DO I LLC®# COMPANY NAMESilva Plumbing&Heating Inc ADDRESS 155 Sudbury Lane R F. C k- IVED CITY Hyannis STATE MA Zip 32601 TEL ..__ SEP 2 R D22 l ' FAX ICELL 774-836-0176 EMAIL virgiliomga@hotmail.com , W J BUILDING (EPART:VIENT So c1G. lS-CO