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HomeMy WebLinkAboutBLDG-23-000671 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE 'August 09,2022 I PERMIT# BLDG-23-000671 JOBSITE ADDRESS 1174 BAYVIEW ST 'OWNERS NAME JEWELL RONALD G OWNER ADDRESS REILLY SANDRA 1101 WORCESTER RD FRAMINGHAM MA 01701 TEL' ' TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 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 1 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 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© OTHER OF INDEMNITY El BOND El OWNERS 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 caddy 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 Joshua Ferreira LICENSE E 16948 SIGNATURE MP©MGF El JP El JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP El A LLC❑A COMPANY NAME: Ferreira plumbing and heating ADDRESS. 2 hathaway rd, CITY berkley STATE MA ZIP 02779 TEL 7742228219 FAX CELL 7742632391 EMAIL S310N M3IA321 Ndld #lJI 3d $ :33d lJIJ Rd 3H1 SV S3AH3S NOIlYOIlddV SIHl oN saA S31ON NOI133dSNI 1YNId AlNO 3Sf H0133dSNI 2:1Od 30Vd SIHI S310N N01103dSNI SVD HDflOH