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HomeMy WebLinkAboutBLDG-22-002567 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK BLDG 22 002567 CITY YARMOUTH _I MA DATE November 04,202' PERMIT# JOBSITE ADDRESS 7 PARSONAGE POINT OWNER'S NAME WALSH TIMOTHY J G OWNER ADDRESS 25 GLENDALE AVE SOMERVILLE-MA 02144 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 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 1 FRYOLATOR FURNACE 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 perm t 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 Matthew Scioletti L CENSE# Massachusetts SIGNATURE MP❑ MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [icioletti Plumbing and Heating ADDRESS. 58 Townhouse Ter, CITY hyannis STATE MA ZIP 02601 TEL 7748100292 FAX ]CELL 7748100292 EMAIL S310N M3IA38 NVId #11W213d $:93d ❑ ❑ 1111213d 3H1 SY S3A213S NOIltl011ddtl SIN! oN so), S31ON NO1103dSNI 1VNId AINO 3Sf1 NO103dSNI LIOd 30Vd SIH L S31ON NO1103dSNI SVJ HDflO