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HomeMy WebLinkAboutBLDG-23-005623 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rCITY YARMOUTH MA DATE April 10,2023 PERMIT# BLDG-23-005623 JOBSITE ADDRESS 11 KINGSBURY WAY OWNER'S NAME GARB JAMES R TRS G OWNER ADDRESS KANE SHEILA A TRS 11 KINGSBURY WAY YARMOUTH PORT MA 02675-1227 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES ❑ NO III 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 0 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 Alex Braga LICENSE# 15668 SIGNATURE MP❑ MGF El JP❑ JGF❑ LPGI ❑ CORPORATION El# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: BRAGA BROTHERS HEATING,PLUMBING ADDRESS. 110 Breeds Hill Rd,Unit 5, CITY Hyannis STATE MA ZIP 02601 TEL 5088274260 FAX CELL 7744870199 EMAIL bragabros(a,comcast.net i,__ SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK R. '�c�- e , r _ - MA DATE , ,� __ : - mout i M 02664 v� Z ©d G3 E 4/6/2022 �i PER _ S . SI E AIIDRESS 11.Kifl S Ur'J W, y OWNER'S NAME Kane A.�fSFieila�TF�S ' �� - APlOw .. kir BU�$P G DAP I ''go— , RESS I i TEL -,:,, _ . : FAX _ __ \\... -U.R v _ NT • 0•, 1 Y TYPE COMMERCIAL EDUCATIONAL v RESIDENTIAL CLEARLY NEW:1 RENOVATION:Li REPLACEMENT: X PLANS SUBMITTED: YES IA NO X APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ t COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE I _ � l FRYOLATOR = — -- FURNACE 1 I� E GENERATOR GRILLE INFRARED HEATER I LABORATORY COCKS MAKEUP AIR UNIT C j OVEN POOL HEATER f. l ROOM!SPACE HEATER ROOF TOP UNIT TEST [----- — — _ ---- — UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER j ___ _ — INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES i : 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. CHECK ONE ONLY: OWNER ' AG 'T 1 4. 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 a r. o the b- .f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance -lPe e . a ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Aie.14 di PLUMBER-GASFITTER NAME IALEX BRAGA I LICENSE#315668 I IGNATURE MP ' MGF L„A JP JGF Ej LPG!rj CORPORATION','#13618 1. I PARTNERSHIP[�# LLC ij#I e COMPANY NAME:,BRAGA BROS.INC ADDRESS 1 110 BREEDS HILL ROAD UNIT 5 CITY HYANNIS __. _.. STATE MA ZIP 02601 TEL j(508)827-4260 FAX508957-2960 I CELL!774 487-0199 1EMAiLbragabros a(�comcast.net