HomeMy WebLinkAboutBLDG-23-001310 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
k.,
�y CITY YARMOUTHSeptember 12,202 PERMIT#
' JOBSITE ADDRESS 50 OLD MAIN ST MA DATE
OWNERS NAME 'BEGGS JEFFREY L BLDG 23 001310 I
G OWNER ADDRESS BEGGS ALBERTA M 14 FORTES WAY OSTERVILLE MA 02655 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL EI
PRINT RESIDENTIAL El
CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ 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
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
•
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST 1
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 0 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 IVirgilio Silva I LICENSE# 131395 I SIGNATURE
MP❑ MGF 0 JP El JGF 0 LPG' 0 CORPORATION 0#I I PARTNERSHIP ❑#I ILLC ❑#I I
COMPANY NAME: IVIRGILIO SILVA I ADDRESS. 1155 SUDBURY LN, I
CITY IHYANNIS I STATE IMA I ZIP 1026012462 I TEL I
FAX I I CELL I I EMAIL Ivirgiliomga a(�,hotmail.com
- L� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-01511e27, ern, o th MA DATE 09/13/22 ? /3/PERMIT#
1 2 ITE ADDRESS 50 Old Main St.
DOWNER'S NAME 'Jeff Beggs
au!I , D S ,.r11(',sEIRESS 50 Old Main St. ''ff
"TYFIE$RTE`l FAX) r.
PRE OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL
CLEARLY NEW: RENOVATION: j REPLACEMENT:
PLANS SUBMITTED: YES N0
APPLIANCES 1 FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER MI
BOOSTER _..
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE — IIIIII
FRYOLATORMI
FURNACE _—__®—�_®�RN
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT ="
OVEN _=` _
POOL HEATER — —
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
1
UNIT HEATER "-
UNVENTED ROOM HEATER = ="
WATER HEATER
OTHERIII
II
■®
mulamormi im,
_ _. ___
_ ,
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES v 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 (_
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 CHECK ONE ONLY: OWNER 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 ' ertinent provisitmof the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J -
E
MP® MGF El JP JGF LPGI CORPORATION # PARTNERSHIP 0# LLC #
COMPANY NAMESilva Plumbing&Heating ADDRESS 155 Sudbury Lane
CITY iHYannis .
STATE MA zip 02601
77483 lE
mAiLvirgiliomga@hotmail.com
TEL
FAX! CELL EMAIL virgiliomga@hotmail.com
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