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HomeMy WebLinkAboutBLDG-22-006606 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .. CITY YARMOUTH MA DATE 'May 17,2022 I PERMIT# BLDG-22-006606 ft- JOBSITE ADDRESS 82 WIMBLEDON DR OWNERS NAME PREZIOSI M TERESA G OWNER ADDRESS CIO CROWLEY DANIEL&KAREN 145 TALBOT ST BROCKTON MA 02301 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES❑ 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 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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❑ 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 'Vincent Marino I LICENSE# 15136 SIGNATURE MP©MGF❑JP❑ JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IBEST YET INSTALLATIONS INC I ADDRESS. 110 Meadow Rd, CITY !Spencer I STATE MA ZIP 01562 TEL 15088852378 FAX I I CELL I I EMAIL 'permitsanbestyetinstallations.com S310N M2IA38 NV1d #111AN3d $ :333 ❑ 0 111183d 3H1 SV SSA83S NOl1VDIlddV SIHl oN saA S3LON NO1133dSNI 1VNI3 KINO 3Sfl i•101O3dSNI ZIOd 30Vd SIHI S310N NO1103dSNI SVO HOfla1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _; �a (06 6 � i CITY , q00( 0 MA DATE S c?1 PERMIT# JOBSITE ADDRESS kJ 1 Vt bj)e p Y1 DY. OWNER'S NAME V.,Goren Ciro".)}e G OWNER ADDRESS 5 jj,,yvve..- TEL Sb.5 .tto?•Li$a) FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: I PLANS SUBMITTED: YES NO +� 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 DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 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 I 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 ✓ AGENT 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 alllertnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,c PLUMBER-GASFITTER NAME \ 1\(\CC` �0�tYU LICENSE# 151 3(2 / SIGNATURE / MP I MGF JP JGF LPG! CORPORATION ✓ # t 53 G PARTNERSHIP # LLC # COMPANY NAME: e3-j- ye-f- J11,3- c 11)jy 5 1YIG.ADDRESS is ).,keoc'o„) . CITY 3p Ge \r STATE vo ZIP QtS(-pa TEL 507•nS-g.3 3 x FAX St3754YSd5 - CELL EMAIL Tbrivt i+S z' a-e.3-��e-�1n3-tct}'G&`ri rtS, coUVI