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HomeMy WebLinkAboutBLDG-22-000581 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7-----L'11; CITY YARMOUTH MA DATE August 02,2021 PERMIT# BLDG 22-000581 ` JOBSITE ADDRESS 21 ATLANTIC AVE V r'+ t A OWNER'S NAME VIRTOM LIMITED PARTNERSHIP G OWNER ADDRESS 2 ATLANTIC AVE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 GRILLE INFRARED HEATER LABORATORY COCKS , MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 , 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 0 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 Virgilio Silva LICENSE# 31395 SIGNATURE MP 0 MGF 0 JP© JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomga anhotmail.com S31ON M3IA32i NVld #lMWN3d $:333 ❑ ❑ 111A1213d 3H1 SV S3A?J3S NOI1VOIlddV SIHl oN saA S310N NO1103dSNI 1VNH ,LINO 3Sfl HO103dSNl 2JOd 30Vd SIH1 S310N NO1103dSNI SVJ HOl0N :. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,k .. ;�4�'� " � 07/29/21 2�- � �� � E Yarmouth MA DATE PERMIT # �� � , CITY JOBSITE ADDRESS 21A Atlantic Ave. ---jOWNER'S NAME Virtom Limited Partnership GOWNER ADDRESS 1A Atlantic Ave. TEL' 'FAX W _ 1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO-a APPLIANCES 1 FLOORS-* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER MIIIIIIIIIIIIIIIIIIIIIIIIIII11111111-11111111111111111111111 CONVERSION BURNER NO W I— 1.11111.a COOK STOVE 111111 ogielluilillimmi'mut' 111-1 MIITIIIIIIII DIRECT VENT 111111/1MMMIIIIIIIIMIIIIIII DRYER FIREPLACE FRYOLATOR E1, I ' 111111.11111011111111111111.1.1 FURNACE GENERATOR NM M11_ r- 111.111111= nag. GRILLE INFRARED HEATER 11 _ I1 LABORATORY COCKS IMPE MAKEUP AIR UNIT OVEN ta POOL HEATER ; i __ ROOM / SPACE HEATER mum 1 ROOF TOP UNIT Ii WNW TEST I Ilff.MI Wili MikliMaiiMifillill UNIT HEATER OM UNVENTED ROOM HEATER ME 1 WATER HEATER - i OTHER WWI IIIIIMMII 111.--W IM 111111111111t INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES v NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY F71 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 0 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 Urgilio Silva 1 LICENSE # 31395 SIGNATURE MP 0 MGF JP 4, JGF 0 LPGI El CORPORATION ®# PARTNERSHIP®#[ LLC E # COMPANY NAMESilva Plumbing and Heating ADDRESS[155 Sudbury lane FR _ 'Hyannis I MA )2601ftEL ...�._ CITY Y STATE ZIP -3�b . FAX CELL7748360176 EMAIL Ivirgiliomga@hotmail.com AUG 0 2 2021 BUILDINGYDEPARTMEN I 1 By -- - -