HomeMy WebLinkAboutBLDG-16-005733 MT
UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
716=. CITY South Yarmouth MA DATE 04/22/16 PERMIT# / 44' 7/ `0o573.�
JOBSITE ADDRESS 82 A River Street Arh( . LU i OWNER'S NAME John Woods
G �_ --
OWNER ADDRESS 82 A River Street B I L t;'e TELL_ FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL 1 RESIDENTIAL✓
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: ✓ PLANS SUBMITTED: YES NOZ
APPLIANCES Z FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER '
CONVERSION BURNER
COOK STOVE It ,
DIRECT VENT HEATER ,
DRYER _
_mY _.:. 1-
FIREPLACE �_ .
FRYOLATOR
FURNACE {
GENERATOR —
GRILLE _ 1 — —� 1
INFRARED HEATER
�. 1 . .. . ...�..1 .
.
LABORATORY COCKS 'a . Y. _
MAKEUP AIR UNIT I
OVEN
POOL HEATER '
ROOM/SPACE HEATER { 1
ROOF TOP UNIT , ._1 ...r_ _ .,_ _.
TEST _ 1
UNIT HEATER �
'-
UNVENTED ROOM HEATER .1
WATER HEATER 1 ,` ,
OTHER — �. __. _�
�_ I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ✓ NO Ti
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 t-of rrTy"krtowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance • ertinent pr 'siort bTth
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _________
PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J l RE
MP MGF JP ✓ JGF I LPGII I CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME:Silva Plumbing&Heating ADDRESS 155 Sudbury Lane
CITY Hyannis STATE MA ZIP 02601 TEL
FAX CELL 774-836-0176 EMAIL virgiliomga@hotmail.com