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HomeMy WebLinkAboutBLDG-22-007255 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �1 CITY YARMOUTH MA DATE June 16,2022 PERMIT# BLDG-22-007255 JOBSITE ADDRESS 36 KATES PATH VILLAGE OWNER'S NAME audrey saftlas G OWNER ADDRESS FL 34104 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES 0 NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 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 1 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 0 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 0 JP© JGF❑ LPG! ❑ CORPORATION 0# PARTNERSHIP 0#I ILLC❑A COMPANY NAME: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL I FAX CELL EMAIL virgiliomgatthotmail.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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK TiR � CITY Yarmouth MA DATEi15/22 PERMIT # t JOBSITE ADDRESS Kates Path OWNER'S NAME udrey Saftlas GOWNER ADDRESS 36 Kates Path TELL IMI11111.111111 TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES .`.:. NOEl APPLIANCES 7 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER r1 _ I ___ CONVERSION BURNER _ COOK STOVE i - 1 ._ - 1 z 11. :. . DIRECT VENT HEATER ii i DRYER I FIREPLACE 1 FRYOLATOR �� :. . FURNACE 4___ �_4 —,-1 GENERATOR L ,. .....k: 'r-- GRILLE r .:�. INFRARED HEATER ...., __ ,....4.---- ,. ,- LABORATORY COCKS "—_ ,,.„ MAKEUP AIR UNIT .. •r+o++. .2 .a.r,.w,e,.;:e. .ter:. L OVEN - POOL HEATER ,,.r;.. ROOM / SPACE HEATER ROOF TOP UNIT 7 TEST UNIT HEATER ,� UNVENTED ROOM HEATER r I i WATER HEATER 1 OTHER ._. __ : .� . v -- —: :-.. „ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO L 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 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 w' nent provisio' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva ILICENSE #31395-J SIGNATURE MP MGF JP Fil JGF LPGI CORPORATION ®# [ PARTNERSHIP o#[ Lc Q# I COMPANY NAME:Silva Plumbing and Heating —1ADDRESS 155 Sudbury lane Hyannis CITY + STATE MA—lapp2601 frEL f FAX CELL774-836-0176 EMAIL virgiliomga@hotmail.com