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HomeMy WebLinkAboutBLDG-22-005310 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r{6 CITY YARMOUTH MA DATE March 23,2022 PERMIT# BLDG-22-005310 JOBSITE ADDRESS 42 LOOKOUT RD OWNER'S NAME KELLPETE REALTY TRUST G OWNER ADDRESS C/0 PETER DOHERTY 10 GLAD VALLEY RD BILLERICA MA 01821 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ 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 HEA"-ER DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEALER 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 sigrature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all cf 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-GASFITTEFI NAME Charles Delvecchio LICENSE# 13269 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: CHARLES M DELVECCHIO ADDRESS. PO BOX 719, CITY FORESTDALE STATE MA ZIP 026440702 TEL FAX 7 CELL EMAIL none S310N M3IA321 NV-Id #1IV d $:333 111eN3d 3H1 SV S3A213S NOI1V0IlddV SIHI oN saA S310N N01103dSNI 1VNId AINO 3Sfl N0103dSNI a0d 3OVd SIH1 S310N N01103dSNI SVO HOflO I „ ,, -;, -- - \ i - C 1 ,'._ `5c.7..+T V., 1M'l\iiFC.:1..Ii A..r• 'tLT IC F v"' ( A F',-*R t1. 70 i:."(7C. ROA VAS . .T : ;iv.w iFi r ( • iA DATE33-11-Z I ?ERMi . , -00t-f- i.;\� -- CBS: AD DRESS t ''42. Look cu g,,D, ' \ ER'S NAME t G . ,,,,..,..,-, ,,,,,,REss i . ........., , ! .. , . , I,...-,A, TYPE OR OCCUPANCY TY PE COVM E� CIAL 0 E✓JCAZONAL D RES:D - 2 P ' t j CLEARLY vE. : L� � N0!AT'OP ' = REPLACEMENT; PLANS SJ3ti1TT ED: !_` :� NOD - - G 9 10 E 11 i ':4' 13 - ::w 3CDNVERSION wjR\cn ♦.. ^ i i __._. COOK STOVE . v 1RECT V�'vT HEA: _ i 1 • - 1 ... t ; RYEr 1 E ” F;REP:.ACE _ I i ; 1 • FRYOLA 1 ..)R ___ . Ors, - _._.__�_ 4 - NF RARED t-iEA, ER t _ LABO TORV COCKS - - i.;AKEVP AIR uNt' { 1 OVEN — _ R. EC �E1VE rCCL ._�h. t_rs - 1 .---L'C'-' 73P 1.,N7 . ' _MA2 1.1122 . _ `•� _ _ _ --- �iZtI;UING DEPARTiViENT ��j `lad i �.''� c , 8 y. _--- -- ---- --- _� i • • __ • -- ..._.-._ _ - ___ i - f I __._�. - ____._-- - INSURANCE COVERAGE I have a current ltanilitY-insurants policy -olio or Its substantiai equivalent which meets the requirements of MGL. Ch. 142 YES . NC E I IF YOU CHECKED YES, PLEASE 1ND1CATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ;.IABIL;TY INSURANCE POLICY OTHER TYPE INDEMNITY E BOND 7 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 0 AGENT D SIGNATURE OF OWNER OR AGENT . t •i cr entere ega:c.,•� t"•s application are true ad - c,�ratA. to the best of -ny kncv,iedge ' hereby ^ F thedetails aro norrna. c� , have submittea ..� Oer♦ne perm t ss;,- fcr tlis aco at•cr; tip•,:! be ,- comci,,arce vital ertfnert crcv.s.or' of The ..��••• • ; �� _� ; 1 � �� n'. i'l.�ta�ia.�ri� : �.G.^V�14L :,nu { ti4 / „ ;F: t=-...mD"ic C;-�e sr:. CT•as.er ;G2 cf :re�Genera; La.' s . cIS L.G:�~..� ..- tl. N t� CC , 1 L 1 1 3'zC ! '4Gr i__-, u' JG*"- ` 1.�G'i E CORPORATICN 3 ' PARTNERSHIP ❑* ; :.LC D# .• L.r� COk'PAV? NA!v-• • '-k-' c-+ ADDRESS ' ?0 !.5C), < 75-S- ! • '.ram. J / ti � �_ ;? — , ��; r t , • ( a(�el 01`1 bat-vs c h24%NJ'V gr..a, , C oP \ 50 --