Loading...
HomeMy WebLinkAboutBLDG-21-002365 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 29,2020 PERMIT# BLDG 21 002365 JOBSITE ADDRESS 134 OCEAN AVE OWNER'S NAME TORRETTI GINO F TR 1 G OWNER ADDRESS THE 134 OCEAN AVE REAL ESTATE TRUST P 0 BOX 135 LUDLOW MA 01056-0135 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ,I 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 1 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 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 James Papasodero LICENSE# 3782 SIGNATURE MP 0 MGF © JP 0 JGF 0 LPGI ❑ CORPORATION❑#_ PARTNERSHIP ❑# LLC ❑#1 --1 COMPANY NAME: JAMES M PAPASODERO ADDRESS. 300 MANLEY STREET, CITY WEST BRIDGEWATER STATE MA ZIP 02379 TEL FAX CELL EMAIL 8577Permits(c,ars.com S310N M31A32J NYld #±IIN213d $ :33d ❑ ❑ ±I1(0:13d 3H1 SY S3A213S NOI1V011ddV SIHi oN s81 S31ON N01103dSNI 1VNId JCINO 3Sl 2,10103dSNl HOd 30Vd SIHI S31ON NO1103dSNI SVO HJnO' a' . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,,!w a It 1€is. CITY South Yarmouth MA DATE' 10/21/2020 PERMIT# „kW 01--CO Z JOBSITE ADDRESS 134 Ocean Avenue l OWNER'S NAME Gino Torretti 1 GOWNER ADDRESS 134 Ocean Avenue TE 413 335-1694 ]FAX[ TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL Li RESIDENTIAL LA PRINT CLEARLY NEW: RENOVATION:1 I REPLACEMENT:[A PLANS SUBMITTED: YES j NO LI APPLIANCES 1 FLOORS—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I _ BOOSTER I.— CONVERSION BURNER (, VY 'in COOK STOVE t l� DIRECT VENT HEATER tu,_ ' DRYER � �i - -" ` ..� FIREPLACE � � � FRYOLATOR .: -17 'r FURNACE L.1 .- :' _. �;._ GENERATOR _1 _ GRILLE INFRARED HEATER L. II , , LABORATORY COCKS E _ , - [ _E f MAKEUP AIR UNIT —11.. OVEN .e ,, POOL HEATER —II --_:.1_- 1--" ROOM/SPACE HEATER ROOF TOP UNIT TEST r 11 [_ , i UNIT HEATER UNVENTED ROOM HEATER WATER HEATER — i OTHER - -_____7,. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L ,y OTHER TYPE INDEMNITY Li 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 El AGENT Pi SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appl' ation are true . -ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application wi e in complia - ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. v�— PLUMBER-GASFITTER NAME James Papasodero LICENSE# 378 - SIGNATURE MP', ] MGF 0 JP® JGF❑ LPGI CORPORATION❑#[171 1 PARTNERSHIP # I LLC®# COMPANY NAME: ARS/Heating&NC Services I ADDRESS 300 Manley St CITY W.Bridgewater 1 STATE I MA IZIP�02379 v TEL 508-588-9025 FAXi 508-588-1059 CELL EMAIL[8577Permits@ars.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 i i I 1 1 s , The Commonwealth of Massachusetts ` at tiIndamial AcetieaNs I � .. � .«.,«:..+..- .„. m_,.„- tees.. ��' t .'1., ' Boston,Min#2114-2017 trwta,atpa.toswa Worker'Compe satIon Irauranee AMris*:BolidieSICoadvetonitleetridansfPlambers. TO ss FILM wnv TUE Plootre 1N0 AtiTMoottTY. I mailgualallarialle Amy NMI Nerve oksinessepshadowiadmdtmeg ARS lieu d NC BeMoee Addroaa:300 WOW et 1 City/Stoical!):Wr 6ildDawatar.Me.02310 Photo)0:308.688402$ Are Tee es etspkrat Caeei tin epprepibt*eau Tn.oft (riquirt4 l.IDIw sa4 dUwib 3 ea pio7eestMmikepowinwl• �`1~' 7_ Q New oonsbthdton !CI I mote Ws preptierer or sod bore er.aaapisyees eating tb►eaein Se 0 Remodeling artrospseb.(No+meats a ems armies mmitell S�i am bstaov eswn dgigr wm rt►ma sa:ma two waders'mem.lesero ee.rep Bred j t 9. Dernotitioa 1t J.OI ea s blame*ad aril be*fop orni aaas to meet ell wart en sty ropey I+e0i 10❑Building sd�iSooa 1 sns .tilt d eaelatA es skier bees wetae•oampareriso lnantewp we leM 1 1.0 Wectricsl repairs or additions ; domain wilts eVesederces 1 12.0 mains or additions Sal air s wad essirsner sod 1 iris bind de nice awned listed as the aasadied Amt. These employees miters wave amp,isnowxat 13.0Roofsepia t in Ws ere a oaepwet�at end Si oetors traits rnsnxbad eteir eipte el exemption per wOL 14.1 Other { 1 S:t,ll(tI,and w boo no employees.Pioaottas'team Wane*remised.) i 'Any applies*the chalet's II obit e o MI eta bee sntion below Aveiro ensS woAeees'eoatommika poloty taieemedlaa $leareoveireMtn Rim Odeell3Qwb IaeEatia6saet era yea ell sex*sad thin Me ass*eawsetoee nom Pelts a.mellitmit Iiik Mataaaek tQoeusedditsteeeoldehtenter ec tsi dallied tsleetlbsaiebdw a edge get meeeieIiesWe wades* Mho w4 awiae+:liqaeo,drtil►a untie lieMdkseeke i oS plir'5 let,..____r_.r-_ ,.__fees I ins au aegodoyvOaf Is proms workers'comparaeafeae bottom rlor moo.i ploy'etiss. Below b Mapoti y and job she hs fornsaflan. insurance Company WIftY Casporeton Policy 0 or Solf.iat.Was il: `', WA7-63D 508631-0191 tiarpiatbn Dab: 10/1/2020 Job Site Address: City/Stets/Zip: Attach a copy of the workers'compensation poky dodtrratlon page(slowing the pokey semrbor sad aspiration dote). failure to secure voreage as required under MOE.a.l S2,12SA is a criminal violation punishable by a fine up to 31,500.00 aaVor ode-yeas impti onmeet,as well has civil paaatties in the Ibis of a STOP WORK ORDER and a fine of sp to 3250.00 a day against the violator.A copy of this steterment may be fbrwarded to the Office of Investigations of the DIA for Insurance /ti' *, Illle- lips)*j AN&thpili emilaalsssi14d*sebarwr�i &rat ipf pewit 5004,8 025 Official es*ants. Do slot write In ebb area,to be a teekted by riff or town ektat City or Town: Perdalt/l,iceose a i sulug Authority(dreie sae): I.Board of Hun 2.Big Deparaaeestt 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Coated Lemon: Phone 0: Aco CERTIFICATE OF LIABILITY INSURANCE (1111 1011/2020 L 9/23/°9/23/Y00"Y'"' 2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the policy(Ns)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Lieu of such endorsement(s), PRODUCER Lockton Companies N6 1E P 1185 Avenue of the Americas,Suite 2010 iT RAC,Not, New York NY 10036 646-572-7300 7;IL WeuRER(eLAFFORW10 COVERAG! NAN aA:Liberty Mutual Fire Insurance Company 23035 e' oAMERICAN RESIDENTAL SERVICES LLC a:liberty Inswance einoiatilan 424074 1073055 dba HEATING&AIR CONDITIONING SERVICES INaurtlrcc: G.��QI)E1p ny 4230y._ BRANCH#8577 Ier%URPR D 300 MANLEY ST. WEST BRIDGEWATER MA 02379 INSURER E: URER P; COVERAGES AMERE02 CERTIFICATE NUMBER: 11465755 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR AOOL'SUBR POLICYEPP POLICYEXP LTR TYPE OF INSURANCE POLICY NUMBER DOWL1YYYY) IMMIOOIYYYYI LIMITS A X COUMERCtAL GENERAL L1ABIlm N N TB2-631-508631-029 10/1/2019 10/1/2020 EACH OCCURRENCE s 2,000.000 RENTED CUS-MADE X OCCUR 'DAMAGE TO L* memoscIc,I $ 1,000,000 MED EXP(My ono parson) $ 10,000 PERsoNAL.d AM SLUR' $ 2.000,000 GEIYL AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE f 4,000,000 POLICY u JELT ❑LOC PRODUCTS•COMP/OP AGO s 4,000.000 OTHER: $ A AUTOMOMMEUA5LITY N N AS2-631.508631-039 10/1/2019 10/1/2020 FearrsEdLsIGLELRIrT $ 2,000000 L x ANY AUTO BODILY INJURY(Per pain) $ XXXXXXX / 0.5 OWNED1M Y SCHEDULED BODILY INJURY(Par accid.M) i XXXXXXX AUTOS X AUTOS ONLY X AUTOS ONLY P EaccidenDDAMAGE f XXXXXXX XXXXXXX C X UMBRELLAUAB X OCCUR N N BOI9UMR7150881V 10/I/2019 10/1/2020 EACH OCCURRENCE $ 5,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE i 5,000,000 CEO I X I RETENTION; 10,000 _ $ XXXXXXX WORKERS COMPENSATION U.'I ON v N WA7-63D-508631-019 10/1/2019 10/1/2020 XSTATUTE I 1 ERA B AND EMPLOYERS'LAAIAAraIuEry OFFICER/MEMBER E CITLI ED TE Yn NIA EL.EACH ACCIDENT $ I,000 00O Mandatary In NH) E.L DISEASE•EA EMPLOYEE $ 1.000.000 U yyap,,Oesa1be undw DESCRa*11OR OF OPERATIONS below E.L DISEASE-POLICY UNIT $ 1.000.000 DESCRIPTION OF OPERATION'S I LOCATIONS I VEHICLES IACORD/01,Additlanal Remota ScbuduIs,ram be M*st K N TWO space I.regidred) THE GENERAL LIABILITY POLICY'S GENERAL AGGREGATE LIMIT APPLIES PER LOCATION AND IS SUBJECT TO A 320,000,000 GENERAL AGGREGATE POLICY LIMIT CERTIFICATE HOLDER CANCELLATION 11485755 EVIDENCE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR A e ,c,C/l + I SILL/Gi ®1 68-2015 ACORD CORPORATION. All rights reserved.+ ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PleayAsit our web site at http:llwww.mass.gov/dpilboards/GF JAMES M PAPASODERO ARS HEATING AND A/C SERVICES (ail 36 CORNERSTONE DR NORTH EASTON,MA 02366-2741 • • fold,Ttwm P.tach Along All Parforat ons rIi..1111:,lit Reid,flan at.It AOPetteoone CONTROL I IMPORTANT DIVISION Of pRorFss►GNAL I.ICENStJFtE If your license s lost,damaged or destroyed;Is inaccurate;or PLUMBERS.AND GASFI. needs to be corrected,visit our web site at mass.govidpl for issv Instructions to ensure the proper mailing of your Renewal REMSTERED GAS QORPORATfON Application and any other correspondence. This license is subject to Massachusetts General Laws and JAMES M PAPASOOTERO regulations,Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this ARS}MAWSMB)A/C SERV1C144, license on your person or posted as required try law and/or 300 MANLEY'B'TREET regulations. WEST BRIDGEWATER M A 8297E 17i OI/01t2o31 81B377 Please visit our web site at http:ilwww.mass.govidpliboardslGF JAMES M PAPASODERO 36 CORNERSTONE OR IGF} NORTH EASTON,MA 023156-2741 Fold,Then Detach Along All Perforations Fold,Then Detach Along All Parforellons CONTROL If J 0 14 c i 9 2 COMMONW •LTH OF M '<�tiu' t Dh l ,l %N OF PROFESSIONAL UPE IMPORTANT ;fi t PLUMBER$AND GASFD T1 needs license bb orrres ctcte damaged or sited at mass.g inaccurate, or I E rTHE FOU.OWNG UCENSE instructions to ensure the proper mailing of your Renewal MSTER eAssrtrER • :4. Application and any other correspondence, This license is subject to Massachusetts General Laws and JAalis M PAPA,8Ito om'; regulations.Your license is a privilege,and cannot be lent or 35 Q TQ DR assigned to any person or entity under penalty of law.Keep this "•" license on your person or posted as required by law and/or NORD N,TO MA 02356+2741 , • jgb, regulations. 3782 0510112022 817283 EKFIFATfur,t'AIL •tlwL