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HomeMy WebLinkAboutBLDG-23-004748 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK fliVIT CITY YARMOUTH MA DATE February 27,2023 PERMIT# BLDG-23-004748 JOBSITE ADDRESS 83 SISTERS CIR OWNERS NAME William Dasilva G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 1 DIRECT VENT HEATER DRYER FIREPLACE 1 1 FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN • POOL HEATER 1 ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 1 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 ❑ 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 LICENSE# 16489 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: PLUMBING SOLUTION BY HAYES ADDRESS. 22 Rustic Lane, CITY Hyannis STATE MA ZIP 102601 I TEL FAX 1 I CELL 17747225013 I EMAIL PLUMB HAYES91 an.YAHOO.COM ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES //D -06 II/IASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "' ham, DATE ccld7J,-3 PERMIT# 1-3 — t'(�c%s IA ? 7 roils EADDRESS $3 S;.Sfer5 t-cU OWNER'S NAME U c. Qg5'Iyti :UILDi c oEP FGr �E ADDRESS S? S;s I. ru(• TEL FAX Y TYPE--OR - PRINT ---" E 7 TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ �,/ PLANS SUBMITTED: YES❑ NO U APPLIANCES 1 FLOORS-{ BSM 1 2 3 4 5 6 BOILER 7 8 9 10 11 12 13 1 4 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - 1.1111i DRYER FIREPLACE i 1 FRYOLATOR FURNACE I GENERATOR I -�J GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ________,_______4 OVEN POOL HEATER t _ ROOM I SPACE HEATER '�� ROOF TOP UNIT TEST _ . _ 11 UNIT HEATER INVENTED ROOM HEATER l WATER HEATER 1,1 I NM OTHER _ _ _______H INSURANCE I have a current liabiIi insurance policy or its substantial equivalent COVERAGE nt which meets the requirements of MGL Ch.142 YES ['NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ❑ LIABILITY INSURANCE POLICY LK OTHER TYPE 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 CHECK ONE ONLY: OWNER ❑ AGENT ID�, ENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc ate 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, Q 1 PLUMBER-GASFITTER NAME R nkc,w l-\&J s LICENSE# IL t$1 SIGNATURE MP f v� IMF❑ JP ❑ JGF El LPG' ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑ COMPANY NAME P Io 11.1b nl S t,[0 4;di s /�„ ADDRESS 2z Qp 5-4i L 1�„._ CITY I c,nn: 5 �JJSTATE Al il ZIP b 2..t,o' TEL FAX CELL 1 -1-Z2-5-613 EMAIL p i v 0. is 9.1 L,,t„p c'' I 1 i czi 1 1 U 1 w 1 C!1 I K. I i 1 i I I I 20 . G ", �D I COLmi I oin 1.11 0 a I r = F MI I— a- - I w o > :. co r4 ...a a-, F- 1 G1 °5q +N 11 I F"1 64 Cil W LI- 1 Ior, LY (J i 0 I Z 0 U I I Li) 1 I I O c4 1 I I