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Home My WebLink AboutBLDG-23-001749 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ; CITY "ARMOUTH MA DATE October 03,2022 PERMIT# BLDG-23-001749 JOBSITE ADDRESS 21 MONROE LN OWNER'S NAME Steven Petluck G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ 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 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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSLRANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND El 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: EIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX ]CELL EMAIL virgiliomgaanhotmail.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 e illtf '' T.' MA DATE 10/03122 i PERMIT# 13 I "7 "1" 'CT 0 �82ITE D''ESS 21 Monroe Lane J OWNER'S NAME Steven Petluck suic �c,�r k OWNERF r D�•ESS 21 Monroe Lane '""4" • ITEM _ FAX 1 R r,� PRINT -.ICC1i�4N Y TYPE COMMERCIAL EDUCATIONAL 'J RESIDENTIAL CLEARLY NEW:❑ RENOVATION: REPLACEMENT: - PLANS SUBMITTED: YES —I NOD APPLIANCES-I FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ■ BOOSTER it CONVERSION BURNER I 11— COOK STOVE DIRECT VENT HEATER DRYER _ FIREPLACE j� FRYOLATOR 1r FURNACE 1 GENERATOR -_ GRILLE IL .__... __. INFRARED HEATER r— ' LABORATORY COCKS .. MAKEUP AIR UNIT OVEN .." El _ ,1_ POOL HEATER -I ROOM 1 SPACE HEATER _ _ _ ROOF TOP UNIT �r- TEST UNIT HEATER UNVENTED ROOM HEATER ti WATER HEATER R27 - _ � OTHER I-- ,, .._.' — r _ L. �- - --__- - _-d INSURANCE COVERAGE I have a current IiabilitLinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EJ OTHER TYPE INDEMNITY BOND j 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 with all provision Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME iVirgilio Silva LICENSE#p1395-J N ----__ MP❑ MGF❑ JP 0 JGF❑ LPGI I.3 CORPORATION®#I PARTNERSHIP D#L LLC nI#L COMPANY NAME ilea Plumbing&Heating ADDRESS[1 55 Sudbury Lane CITY Hyannis STATE MA ZIPr2601 1TEL I FAX 4 CELL774-836-0176 EMAIL irg}Iiomga@hotmail.com i