The URL can be used to link to this page

Home My WebLink AboutBLDG-22-001332 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 08,202 PERMIT# BLDG-22-001332 JOBSITE ADDRESS 95 PLEASANT ST OWNER'S NAME George Rodrigues G OWNER ADDRESS SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—0 BSM 1 2 I 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 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 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 ❑ 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 virgiliomgana hotmail.com S310N M3IA3?J NVId #111Na3d $:33j ❑ ❑ 110183d 3H1 SV S3A1i3S NOI1V0IlddV SIH1 oN saA S310N NOI103dSNI 1VNIj AINO 3Sfl 80103dSNI NOd 3SVd SIHI S310N NO1103dSNI SVJ HJf1021 - --MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 µ --. 611V/t, CITY Ya muth I MA DATE9/02/21 PERMIT # 27 — I .. ..3'2 U 2 PIAITEADbRESS 95 Pleasant St. --JOWNERS NAME George Rodrigues BU l jG UE ' t 7i dRESS 95 Pleasant St. TEL FAX PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL �� CLEARLY NEW: , RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOO APPLIANCES Z FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ BOOSTER Lr — CONVERSION BURNER , COOK STOVE - . _ MOW DIRECT VENT HEATER DRYER IIIII I _ FIREPLACE 1 IMF __ - FRYOLATOR — FURNACE ME MO .- GENERATOR - .�_�. _ ..e� � ...�_,._. ,n. �.:�._..�.� GRILLE 1 INFRARED HEATER f _ .. LABORATORY COCKS ' MAKEUP AIR UNIT ' I OVEN [.- POOL HEATER 1 1 r _-- i. E ROOM I SPACE HEATER iWi r O ' ROOF TOP UNIT i . _ N FM, TEST ..... 1 WEN i UNIT HEATER LT 1110=1,_ __ ._. ij.. _�.�._�UNVENTED ROOM HEATER it 1 _ fir - En WATER HEATER -MI MI OTHER r riftiMiliMliiMirllnMir—imiIIIIIIIIIIIIIINMMI r r--- ---,r--- —T w ME INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO E 1 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 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 accur f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli ith all Pertinent pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva (LICENSE #31395-J SIGNATURE MP MGF JP v JGF LPGI CORPORATION Elit PARTNERSHIP (j#L. LLC D#, I COMPANY NAME:Silva Plumbing & Heating —"ADDRESS 155 Sudbury Lane I CITY Hyannis , STATE I MA Iz1PP2601 TEL FAX CELL 7748360176 JEMAlLvirgiliomga@hotmail.com