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Home My WebLink AboutBLDG-22-000622 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'Tif7 .--';1 CITY YARMOUTH MA DATE August 04,2021 PERMIT# BLDG-22-000622 JOBSITE ADDRESS 106 CAPT YORK RD OWNER'S NAME CARVER ROBERT J G OWNER ADDRESS CARVER PAUL J 39 DUDLEY ST MARLBOROUGH MA 01752-1816 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 1 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 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: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomgaat hotmail.com S31ON M3IA32!NVId # $:33d ❑ ❑ 111%13d 3H1 SV S3A213S NOIiVOIlddtl SIH1 oN SBA S310N N01103dSNI IVNId AINO 3Sf1 N0133dSNI aOd 3OVd SIHl S31ON NO1103dSNI SVO HOflO e`' -- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , t.=u .;; . IN! rrnouth MA DATEP7/27/21 PERMIT # '2Z— Co Z "Z., j <5.i � f~ 06 Captain York Rd. L,,,_ i JOBEIADDRESS� p OWNERS NAME 1 r . w IF6 Captain York Rd. — � ( . : P �WN� ADDRESS P TEL FAX 1 COANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL P i CL : s. 1 ►Y:LI RENOVATION: REPLACEMENT: - PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER MIjI! IMI COOK STOVE 1 _I 1�_ DIRECT VENT HEATER nil DRYER FIREPLACEum FRYOLATOR _ FURNACE moimmuumi1111111111111111111 GENERATOR — 1M MI GRILLE MI MIK : MN'Ill INFRA allll, - i. RED HEATER LABORATORY COCKS MI WNW Eggimummur 111111011mir MAKEUP AIR UNIT m— MIIIIIIIMMIWOOTT OVEN ME Mr_ - --- POOL HEATER I millilim mu ma I — ROOM / SPACE HEATER .. ROOF TOP IIIIMMIIIII11.11111111111==. 11.11011111111111.111111M1111 TEST 1111.0101111111 IMF iliiiiiiiiiMiliM NNW MS MEM UNIT HEATER ice ; '� MMI UNVENTED ROOM HEATER _ =Ma_ WATER HEATER _ - ... 11111 OTHER [ 1111111M0111111MMI W " I O� IIM __ I ,M11 �� 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 v OTHER TYPE INDEMNITY BOND U 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 lD 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 a d-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 cgarptiince with all Pertinent provision o the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i - f PLUMBER-GASFITTER NAME irgil� lio Silva .._...iLICENSE #31395-J GNATURE MP MGF JP JGF LPG' CORPORATION L# [ 4 PARTNERSHIP❑#L .1 LLC ❑# COMPANY NAME:Silva Plumbing & Heating ADDRESS 155 Sudbury lane CITY Hyannis ..._iSTATE MA ZIP D2601 IraI FAX CELL7748360176 'EMAIL virgiliomga@hotmail.com