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HomeMy WebLinkAboutBLDG-23-005613 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1a CITY YARMOUTH MA DATE April 10,2023 PERMIT# BLDG-23-005613 JOBSITE ADDRESS 657 WILLOW ST OWNERS NAME GENTILE LOUIS J JR G OWNER ADDRESS GENTILE DENISE A 5 MEADOW LN WOBURN MA 01801 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El 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 1 DIRECT VENT HEATER DRYER FIREPLACE 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 1 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 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 Charles Delvecchio LICENSE# 13269 SIGNATURE MP© MGF ❑ JP El JGF❑ LPG' ❑ CORPORATION❑#I_ PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [CHARLES M DELVECCHIO ADDRESS. PO BOX 719, CITY FORESTDALE STATE MA ZIP 026440702 TEL FAX CELL EMAIL capeolumbingandheatinqnagmail.com S31ON M3IA3H NVId #11W213d $ 33d 11W2J3d 3E11 SV SAS NOI1VOIlddV SIHl oN seA S310N NO1131dSNI IVNId AINO 3Sfl 210103dSNI HOd 39Vd SIHl S310N NOLL3 dSNI SVO H0110d __ -- -- - .-7 - ;,,-^ -AP F...Z A?LRiY.R .. 1-"ERFOtM GAS . •T INC1'fi:RX ��:�5.�'.4:.Y..: z.i.7:.ill.. t.:"c:�ll r'�. ..----- ...r. •'S',_:, : C,-v 1 f 5 -}� yt -ptJ}t-.�" i MA DATE; 4-� -2 I PERK rii T# - ` --7 C'tfjti � ,.•�, • . �'^�' :.yS E ADDRESS I /.75-T 1 !O 1 ER'S NAME ►g :,\E�ADDRESS I I TE4 IFAXI G r127- TYPE OR OCCUPANCY TYPE CO;vtP,IERCIAL❑ EDJCATIONAL❑ RESIDENTIAL RINT PLANS SUBMITTED: YES ; ;vim❑ P RENOVA-�ON:LJ REPL ACEME1- ❑ CLEARLY NEW: ` i 7 S g 10 11 i '2 13 hpD�N' PS- �_OO'RS-. - `S:- I _ BOI' ti -- - I I BOOSTER_ _ �_. - - �- - _ _ i_.. _._i_ COOK STOVE T., S DIRECT VENT HEATER I ! I , DRYER ''0 i H - : : l i F.R PJ�CE __ i • FRYO_ATOR ---. —_ GE\ERATOR - INFRARED!-EATER ` --- LABORATORY COCKS f LIAKEU0 AIR SNIT ' OVEN _ _- rwL-tEA E - j . ROOM r SPACE;.EA'cR _---- --- I :ZCCP- - - - E -� • ;hi' HEATER ` ' APB 19 Z023 --- _Jt�VENTED ROOM HE.A-ER -V ►T �-="� �1 ,1,, HJL t� Ark l Al�r=P'T �' C@ ---- it --"- --- -- - INSURANCE COVERAGE I have a current liability insurance 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 :.IA3ILITY INSURANCE POLICY 2/ 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 aapiication waives this requirement. CHECK ONE ONLY: OWNER ❑j AGENT E SIGNATURE OF OWNER OR AGENT /.--."--1 1 tterety cerity that at of the details aro Information I have submitted or entered regarc:ng th:s application are true$no c rat*to the best of-ny knower.' aro,idt a!':„'it' Lvcrd arc 'staliatiortt de'o ec Lncer a berm t iss ac`..'t^,it:aco cat•or isi;!be corn roe 'tt<j ert rlert orovis.or of the .'asses ..:ar.."_t to P.,..mc1g Code arc�`acter;c22�cttne Generat'_ava ER E '..1\ LSv� �jYXi1.-ec&t,L L CENSE it! I3�I SIGNATURE ,'a w 1GF „a❑ ,;G;❑ L?Gi❑ CORPORATION' `PARTNERSHIP❑#: i'_LC❑#' COMPANY NAME:i C1�'OL 4/4- 4 I ADDRESS' po AC 75 I � -� 7'Y ' : 2S- r, --=3Y-1 1�_ i STATE Z9: 0 t-I Li '�'=_L •.:S APPL!CAY1CN SERVES AS T=+E PER6.1;7 YES NO FEE' S _ 0,6)