Loading...
HomeMy WebLinkAboutBLDG-22-006233 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE April 29,2022 PERMIT# BLDG-22-006233 I_ JOBSITE ADDRESS 180 WILFIN RD I OWNER'S NAME Joshua Bilotta G OWNER ADDRESS MA02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 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 FRYOLATOR FURNACE 1 - 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 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 Douglas Langtry LICENSE E 11305 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION El IS PARTNERSHIP ❑# LLC❑# COMPANY NAME: DOUGLAS P LANGTRY ADDRESS. 11268 ROUTE 28,1268 ROUTE 28 CITY S YARMOUTH STATE MA ZIP 026644459 TEL FAX CELL EMAIL Idougaquana,comcast.net S31ON M31A3b NVld #1IW2i2d $ :33d ❑ ❑ 11IN 3d 3141 SV S3AH3S NOIJVO lddd SIHI oN saA S31ON NO1103dSNI 1VNId AlNO 3Sf1 10103dSNI 210d 3OVd SIHL S31ON NOI103dSNI SYJ HOf108 _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1F� CITY M! Ilk YARMOUTH MA DATE 4/26/2022 PERMIT # .7-- 1- — '-'3�_ JOBSITE ADDRESS 80 WILFIN ROAD OWNER'S NAME JOSHUA BILOTTA COWNER ADDRESS 50 BILOTTA WAY, FITCHBURG, MA 01420 TEL 617-719-2114 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL • PRINT CLEARLY NEW: ■❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ■ APPLIANCES Z FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER t COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE . FRYOLATOR FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent 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 U OTHER TYPE INDEMNITY ^ BOND n 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 71 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 compli ce with all Pertin t ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r / PLUMBER-GASFITTER NAME DOUG LANGTRY LICENSE # 11305 TUR MP ❑� MGF ❑ JP n JGF LPG' ❑ CORPORATION ❑ # PARTNERSHIP (i # LLC ■❑ # 3081 COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1200 ROUTE 28 CITY SOUTH YARMOUTH STATE MA Zip 02664 TEL 508-619-3367 FAX 508-619-3367 CELL EMAIL DOUG-AQUA@COMCAST.NET 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