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Home My WebLink AboutBLDG-23-004244 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'j:) "" ) CITY YARMOUTH —I MA DATE January 31,2023 PERMIT# BLDG-23-004244 JOBSITE ADDRESS 37 LONGFELLOW DR OWNER'S NAME MOYNIHAN GIOVANNA A TRS G OWNER ADDRESS PELLEGRINI JOSEPH TRS 82 BOUTELLE ST LEOMINSTER MA 01483 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El 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 1 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 ❑ 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 Virgilio Silva LICENSE# 31395 SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: C/IRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomua a(�,hotmail.com 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 6C) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK a ti= __r Y •rt MA DATEp1/31/23 PERMIT # Z ) `'I `a'`1 � h ��" � A� 3 J�OBSITE ADDRESS 37 Longfellow Dr. IOWNER'S NAME ,�1P � -- ,`�'MER AObR SS r Longfellow Dr. TEL FAX BU ING U i MENT P 4 OCCUPA PE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: E, RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO 71 APPLIANCES Z FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER r ir-- BOOSTER CONVERSION BURNER L. — Cu , — -IIIIIIIIIIIIIIIIWII- 0111111101.11111.0111 COOK STOVE DIRECT VENT HEATER E — DRYER , — — , Ill FIREPLACE 1 FRYOLATOR waif sr .=m allitw, �._ _,.L.— 11111110"111.111111111 FURNACE ,.. _ i - H Ir 1 GENERATOR I___ , - I GRILLE ," ._ __ . 11 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT [._ 1, i _ � OVEN rR ' _ POOL HEATER ROOM ! SPACE HEATER I _ ROOF TOP UNIT M Mg4IMMiliiil FIIIIIIMMIIIIIMMIIIWTMIII TEST UNIT HEATER I „ ! - ,.. UNVENTED ROOM HEATER r. WATER HEATER I OTHER i 1 INSURANCE COVERAGE I have a current liability_insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ' NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY - OTHER TYPE INDEMNITY El 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 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 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 Uirgilio Silva iLICENSE #31395 J SIGNATURE MP MGF 0 JP F JGF L LPG! ® CORPORATION El# PARTNERSHIP❑#L JLLCD# ; COMPANY NAMESIIva Plumbing & Heating ADDRESS 155 Sudbury Lane annis MA 32601 CITY Y STATE ZIP TEL 774-836-0176 1EMAIU1irgiliomga@hotmail.com FAX CELL EMAIL :d@1x3+d vit(',;{3-$i a taft,!}f?;v < .-,.R�, e`±A A7N.`3 RSA • p •. ,e: aeP.v�a, w 4. ZJ1ffiZ :13Tt't:x3Pc'WG-.:- �T!"',- -. ,J:' 5 ems,. fro.1 ice, �. .y - e,.i-:aofi'amamanbeac y�aee, -.. _ -