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HomeMy WebLinkAboutBLDG-23-005256 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK a �1 CITY YARMOUTH MA DATE March 24,2023 PERMIT# BLDG-23-005256 -/ JOBSITE ADDRESS 57 KENCOMSETT CIR OWNER'S NAME ARAUJO RICHARD M G OWNER ADDRESS ARAUJO CLAUDINE M 57 KENCOMSETT CIR YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO FIXTURES FLOORS—> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER 1 FIREPLACE FRYOLATOR FURNACE 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF 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 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 Araujo LICENSE# 10617 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: RICHARD M ARAUJO ADDRESS. 156 MAIN ST, CITY SOUTHBOROUGH STATE MA ZIP 01772-1432 TEL FAX CELL EMAIL sciapa(a7,aol.ocm -, F 1 ` ^A •SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK § : MA DATE 3" 20Z.3 -_-EMIT —2 3_ 66 5-46 _ JOB' E �LIRESS `7MS L'a/ZCtt_IT OWNER'S NAME 4I�-(, �C� ;UIL► Ne DEP RTMENT .Y•— —".' ....,... -'L DRESS d44fi(:f ' v > }•O TEL�8 'i2l?li' TYPE R FAY, OCCUPANCY TYPE COMMERCIAL E Al ❑ EDUCATIONAL L CLEARLY IONAL ❑ RESIDENTIA INT NEW;❑ RENOVATION' REPLACEMENT: ❑ PLANS SUBMITTED: YES 0 N0,* APPLIANCES 1 FLOORS-4 6SM IIIII 9 BOILERElm 6 � y to EMS l J 14 BOOSTER - CONVERSION BURNER El Inn DIRECT VENT HEATER DR1131 YER LIII FIREPLACE C 1111111 FP,I'CiLATOR • 11221211 GENERATOR LE _� 11111111111111.1 - INFRARED HEATER --I LABORATORY COCKS MAKEUP AIR UNIT ---1 I11111.1111111.11 POOL HE?•TER __—EZEREME IIIIIM1=_ ROOF TOP UNIT III UNIT HEATER UNVENTED ROOM HEATER �� � IMEIlagl_� �_ WATER HEATER1 NMI ----i-1101111111 MIN imm................._11111111111111_______ 1111111M1 NM ..................... MIN INIIM INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of IUIGL.Ch.142 YES ❑ 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 Massarhuset • renal Law and that my signature on this permit application waives this requirement. r .� SIGNATURE 9' OWNER OR AGENT CHECKONE ONLY: OWNER AGENT El . •• I hereby certify that all of the details and information I have submitted or entered regarding this application are true a a urate o th best of myknowledge `` and that all plumbing work and installations performed under the permit issued for this application will be in compile c I h ''`' Massachusetts State Plumbing Code and Chapter 142 of the General 4 P Laws. P rtin nt provision of the PLUMBER-GASFITTER NAMELi LICENSE# P itrcl7 SIGNAT RE MPP MGF❑ JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP 0# LLC COMPANY NAME g /liJ A: I ADDRESS / ' itin—fit/s?=i CITY U) STATE AM— ZIP 6/7 17 TEL X FAX CELL 08 7 Z 06‘.38 EMAIL S L/ i" Q 1 Jt-r COH COM ON , EALTH OF ASSA HUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE JOURNEYMAN PLUMBER RICHARD M ARAUJO 156 MAIN ST W . SOUTHBOROUGH, MA 01772-1432 U 18247 05/01/2024 202446 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER COMM•A WEALTH OF , A ACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE MASTER PLUMBER RICHARD M ARAUJO 156 MAIN ST SOUTHBOROUGH,MA 01772-1432 (.43 10617 05/01/2024 201535 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER