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HomeMy WebLinkAboutBLDG-22-003900 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�' CITY YARMOUTH MA DATE January 13,2022 PERMIT# BLDG-22-003900 • JOBSITE ADDRESS 137 BEACON ST OWNER'S NAME BUCK JUDITH G OWNER ADDRESS 137 BEACON ST SOUTH YARMOUTH MA 02664-1853 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: m 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 1 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 Matthew Scioletti LICENSE# ma SIGNATURE MP❑MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Scioletti Plumbing and Heating ADDRESS. 58,townhouse ter,townhouse ter. CITY hyannis STATE MA ZIP 026010000 TEL FAX CELL EMAIL S3 LON M3IARH NVld #1I1A1213d $ :333 ❑ ❑ 111,\Md 3141 SV S3AN3S NOLLVOIlddV SIHI ON Se), S3lON NO1103dSNI 1VNI3 AlNO 3Sfl O103dSNl 2I0d 3OVd SIHI S3lON NOI103dSNI SYJ HOflO I