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HomeMy WebLinkAboutBLDG-22-005066 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY LARMOUTH MA DATE (March 14,2022 I PERMIT# BLDG-22-005066 JOBSITE ADDRESS 149 EXETER RD I OWNER'S NAME PITURRO GREGORY L TR G OWNER ADDRESS GREGORY L PITURRO LVG TRUST 950 STONY LN NORTH KINGSTOWN RI 02852 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL1:1 RESIDENTIAL ID PRINT CLEARLY NEW: 0 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 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 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 'Scott Reid I LICENSE# 16354 SIGNATURE MP©MGF 0 JP❑ JGF❑ LPG( ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: I I ADDRESS. IPO Box 222, CITY 'Harwich Port (STATE MA ZIP 02646 TEL 15082413773 FAX CELL 5082413773 EMAIL 1 S310N M3IA32I N`dld #±I1A2I3d $:33d El El 111V:13d 3H1 SV S3Ab3S NOIIV011ddV SIH1 oN seA S310N NO1103dSNI lYNId AlNO 3Sf1 d0103dSNI ZIOd 39Vd SIHI S310N N01103dSNI SVO HOflO I