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Home My WebLink AboutBLDG-23-00592 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " CITY YARMOUTH MA DATE 'August 04,2022 !PERMIT# BLDG-23-000592 1 JOBSITE ADDRESS 17 LAKEWOOD RD OWNERS NAME TILDES ANNE M G OWNER ADDRESS 17 LAKEWOOD RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL 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 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 ❑ 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 IVirgilio Silva I LICENSE# 31395 SIGNATURE MP 0 MGF❑JP Q JGF❑ LPG'0 CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: IVIRGILIO SILVA I ADDRESS. 1155 SUDBURY LN. CITY IHYANNIS 'STATE MA ZIP 026012462 TEL FAX CELL I I EMAIL IviroiliomgaWhotmail.com ' S310N M3IA32i NYld #iIW0:13d $ :33d ❑ ❑ 1IW2Ed 31-11 SV S3/113S NOLLVOIlddV SIHI oN se), S310N NOI103dSNI 1VNld AlNO 3Sfl 80103dSNI 2i0d 39Vd SIHI S310N N01103dSNI SVO HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . j�, CITY Yarmouth MA DATEP8/03/22 PERMIT # 2 �- aS c1 �' JOBSITE ADDRESS 17 Lakewood Rd. OWNER'S NAME pamion Johnson GOWNER ADDRESS 17 Lakewood Rd. TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NOI APPLIANCES 7 FLOORS--. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 4 .-_ - _ .. - BOOSTER —ii r :i- „..... ,CONVERSION BURNER ------ ___+.. - -- COOK STOVE DIRECT VENT HEATER DRYER kr_ FIREPLACE rlisi= ---_.:_-_ :sEir. , FRYOLATOR FURNACE ` 1L GENERATOR r ___.,„ - v.___L, A-- _ _. ,, , GRILLE Q� in INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT L. _. OVEN 1-" _lir POOL HEATER . _ . . . . _,..= �... ROOM / SPACE HEATER 7 _-�- _A .7. - _._.__ __. - ROOF TOP UNIT - _. I L ._. - TEST IMF _. ►, ----igg4 UNIT HEATER _.n a . 'i __ _ _ L_ UNVENTED ROOM HEATER 1r WATER HEATER '� _ OTHER I � � _J _. 3 -. 0' ,egidlimo INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO 0 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 p AGENT SIGNA--URE 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 wi provisi the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �-- PLUMBER-GASFITTER NAME Vrgilio Silva LICENSE # i1395-J 1 NATURE MP MGF L JP 0 JGF ® LPGI i CORPORATION rj# r -' PARTNERSHIP❑#I LLC ®#, COMPANY NAMEpiIva Plumbing & Heating ADDRESS 155 Sudbury Lane CITY Finnis STATE MA ZIP D2601 ITEL I FAX 1 CELL7748360176 EMAIL irg�diomga@hotmail.com