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HomeMy WebLinkAboutBLDG-23-000074 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK fit CITY YARMOUTH MA DATE July 06,2022 PERMIT# BLDG 23-000074 ' ‘‘ Wi JOBSITE ADDRESS 59 SCHOLL AVE OWNER'S NAME SIMONETTI BRUNO S G OWNER ADDRESS SIMONETTI ELIZABETH A 37 BRIAN DR BOLTON CT 06043 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ElRESIDENTIAL ❑ CLEARLY NEW: 0 RENOVATION:0 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 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 1 OTHER DESCRIPTION:reroute gas main for new meter location INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. El NO ElYES IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ 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. 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 (Andrew Hayes I LICENSE# 1.16489 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG( ❑ CORPORATION❑# COMPANY NAME: PLUMBING SOLUTION BY HAYES ADDRESS. PARTNERSHIP El#��LLC 0# CITY 122 STATE MA ZIP 02601 TEL FAX CELL 7747225013 EMAIL PLUMB HAYES91(a�YAHOO.COM MI=SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - MA DATE .�/ I. Z —, PERMIT IT ju 6 ZI1 �ES E 'DDRESS S SGhD�I l� y�'� _ rt . ((''�� OWNER'S NP,ME�vT+J;'10 cin Q,� I CUILDI DEPA TM DDRESSS`T Sc.hbi.l AAz ` TELSICS - yY' ?�� FAX'P� . ' JCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL [ �Pb CLEARLY NEW:[/ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO� II APPLIANCES -.IFLOORS-+ sSM t 9 BOILER =111113 BOOSTER _Ell CONVERSION BURNER, COOK STOVE all DIRECT VENT HEATER DRYER FIREPLACE 111 N. FRYOLATOR FURNACE GENERATOR all GRILLE ______________ 1111111 INFRARED HEATER --I LABORATORY COCKS ---- =—___________I MAKEUP AIR UNIT OVEN IIIIIIIIIIIIIIII POOL HEATER =_— • ROOM/SPACE HEATER ROOF TOP UNIT - TEST _ UNIT HEATER UNVENTED ROOM HEATER1..1 11111. I WATER HEATER OTHER INSURANCEIMMIIIIIIMMI171"allEllill11111111111111111.1 — MIL_____________ I have a current lia bili insurance policy or its substantial equivalent which CVERAGE I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE sAPPROPRIATE the requirements Bf�OC7X of MGL,Chi YES LJ 6�0 ❑ BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY D 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 wwaives this requirement. I ",-, SIGNATURE OF OWNER OR AGENT CHECK►NE ONLY: OWNER ❑ AGENT ❑ '1:: I hereby certify that all of the details and information I have submitted or entered regarding this application are true and and that all plumbing work and installations performed under the permit issued for this application will be in compliance with P • Massachusetts State PlumbingCodeaccura` to the best of my Knowledge `Z and Chapter 142 of the General Laws, Pertinent provision of the PLUMBER-GASFITTER NAME 4-nditt. geode S LICENSE#f 4YSrY SIGNATURE MP MGF❑ JP ❑ JGF❑ LPGI ❑ CORP ORATION ❑# PARTNERSHIP❑ COMPANY NAME :s•M LLC El#: ant vigL 3- "j ADDRESS au CITY_ W,yh�"s d— • L STATE _ ZIP 0`_G d3 FAX TEL FA CELL }3y- �27 - .ca.5 EMAIL 4-%• (.4. {. ,