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HomeMy WebLinkAboutBLDG-22-007436 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE 'June 27,2022 I PERMIT# BLDG-22-007436 ''� JOBSITE ADDRESS 33 ALMIRA RD OWNER'S NAME herbed holske G OWNER ADDRESS MA 02638-2243 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO 0 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 • 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 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 Francois Paravisini LICENSE# 15211 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP 0# ILLC❑# COMPANY NAME: FRANCOIS PARAVISINI ADDRESS. PO Box 2585, CITY Orleans STATE MA ZIP 026536585 TEL FAX CELL EMAIL bayside(o�thecanecodplumbers.com S310N M3IA321 NVId #IM d d $ :33d ❑ ❑ 11161213d 3H1 SV S3A83S NOI1V3IlddV SIHI oN saA S31ON NOI103dSNI 1VNId AlNO 3Sfl W103dSNI 210d 3OVd SIHL S310N NO1103dSNI SV0 HJf1al t 1 AP 06 i&( o' I © 1 z MASSACHUSETTS U. 3 ; -_y _____74NIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ------ -------- =� i} _ CITY !. r 0 MA DATE, .� `� ? -Da- PERMIT # Z Z 14 3 4 JOBSITE ADDRESS[T ' ' /7-7,--, I? r,A OWNER'S NAME GOWNER ADDRESS �� TELUyl �� ., FAX i TYPE OR OCCUPANCY TYPE COMMERCIAL , EDUCATIONAL I RESIDENTIAL PRINT CLEARLY NEW: s RENOVATION: ; REPLACEMENT: L PLANS SUBMITTED: YES [ NO[ 1 APPLIANCES Z FLOORS-+ BSM ii 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER T.._ : _ r I -�7 �..--�.. .�...II .L_ .J T �. "` - 7 BOOSTER E _. .� -y - v_ a CONVERSION BURNER 4 1- _ T v..� .Y . � . IOW _.�� COOK STOVE a � - �`_ _ . - �-._--_ _� DIRECT VENT HEATER !.1 -1 . .-1 ._ .T �.� 111111 .7-1 DRYER ._. ._ av ..._._ __ ,� . I -11.7.:,:i _ FIREPLACE _r._ t � rr�.i..� .T.. -- ----- _- - f ----1-- T rN r LLA i OR -4 ,----.- __.. - FURNACE ',.:,--1; i' I I. J GENERATOR _.�..._ _ .T . . . GRILLE . I 7_ I'T-I INFRARED HEATER 1_ LABORATORY COCKS I —71 F MAKEUP AIR UNIT -�-__-- ---- 1 _ 7 _1 .�. .,.e., OVEN _ _ . _ � !' POOL HEATER _ '�. - 3 ROOM / SPACE HEATER �: --- ---- I t 4 ROOF TOP UNIT --� - _._ . ;.__:_�.__ -- .� _ � �, � �.�. .�. # .! l TEST [ - �. _ �..,�.. ... _,_ �__ -� 1��.,� � -i ,, ti UNIT HEATER .i _ i�. �_ ; ----3 - C _......L___ M UNVENTED ROOM HEATER ^� i ----3 --1 - - -- ._` _ -. ....., __- - ;9[�ri,L,-,.r . �. _ ._�i _ WATER HEATER OTHER f _�. _. _ , __: _ . . , ;- -.-, ------1 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ry NO [- I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 11 OTHER TYPE INDEMNITY j .. BOND 1 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 i SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application true nd ccurate to the best of owledge and that all plumbing work and installations performed under the permit issued for this application will be in mpli ce ith all Pertin vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Francois Paravisini LICENSE # 15211 i SIGNATURE MP , MGF 1g , JP ; JJGF Li LPGI El CORPORATION ; ;''# F4288 PARTNERSHIP J# LLC Ditl. COMPANY NAME:[Snows Fuel Co _ ADDRESS `18 Main st __ _� CITY Orleans 1 STATE ; MAJ ZIP[02653 JTEL L5o8-255-1o90 1 FAX F-- CELL EMAIL bayside@thecapecodplumbers.com