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HomeMy WebLinkAboutBLDG-22-001527 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 6t` BLDG 22 001527 11/4„'I' � CITY YARMOUTH MA DATE September 16,202 PERMIT# JOBSITE ADDRESS 53 LEWIS BAY BLVD OWNER'S NAME DAMICO JOSEPH A TRS G OWNER ADDRESS DAMICO ZABELLE G PO BOX 41 HOLDEN MA 01520-0041 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ED PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 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 GENERATOR 1 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 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 0 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 Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF 0 JP❑ JGF 0 LPGI 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsa(�efwinslow.com S310N M3IA3 NVId #1IWN3d $:33d ❑ ❑ 111,1213d 3H1 SV S3A83S NOIlv011ddV SIHl oN seA S310N N01103dSNI 1VNId A1N0 3Sf1 80103dSNI 2lOd 3OVd SIHl SALON N01103dSNI SVJ HOl0N MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ►Awl. --, '�� 1_=tl CITY I YARMOUTH MA DATE 9/8/21 PERMIT # _._, p as R.cau Aam�a�u...snaactt:.»w>.uu\uaacw�muamuucau ua u.0\ax<w,c....aaysauuuxaa\auauuu� _ y JOBSITE ADDRESS 53 LEWIS BAY BLVD, WEST YARMOUTH OWNER'S NAME JOSEPH DAMICO G OWNER ADDRESS SAME TEL 5087751889 FAX [I.,..•.....N\k..f' TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: i RENOVATION: REPLACEMENT La.,,._4 PLANS SUBMITTED: YES NO APPLIANCES 7 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 t{ - PUPNiorF GENERATOR 1 - GRILLE i. . INFRARED HEATER '' LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER . .w \ OTHER iiMikl&AA 4SEavu:AiNa4n,• ... .. .. A* laA\... .. ... ... ..... ttmwc _. _.. _. "` _. I.,, auvmwemx w.C...,,;«.u....c,,,,avaa„v<a,,,,,,,,,ou„xnvnmcrnVON.V.auwaaua,,M,A4,m,,,I0X F,V \u,. •w• a a.:,,caw.. uuo` .;:.:r>,u.. .:.x:«o»•.,....:.:au.,xausauwa,.snu.um zuc.aauuucs<.;;.. .. _... .. _:..:_ - . ..... _.. .. :> <,.:... INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ' d NO Li I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. CHECK ONE ONLY: OWNER f'..---71 AGENT 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 b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r ---. ...vs...0/:.......- PLUMBER-GASFITTER NAME = STEPHEN WINSLOW LICENSE # 12298 SIGNATURE JGF LPGI CORPORATION # 3281C PARTNERSHIP #' LLC #1 MP ' MGF JP r COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING i ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH j STATE MA j ZIP 1 02664 1TEL 508-394-7778 FAX1 508 394 8256 : CELL' NIA EMAIL INSPECTIONS@EFWINSLOW COM J