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HomeMy WebLinkAboutBLDG-22-007126 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE June 08,2022 PERMIT# BLDG-22-007126 Iz JOBSITE ADDRESS 18 OAK GROVE RD OWNERS NAME MILOT WILLIAM J OWNER ADDRESS MILOT JILL S 8 NORTH WALKER ST TAUNTON MA 02780 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED:YES El NO 0 FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 1 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE 1 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 2 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 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 Laester Vargas LICENSE# 16039 SIGNATURE MP©MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Vargas Plumbing ADDRESS. 20 Middle St, CITY West Newbury STATE MA ZIP 01985 TEL 7818661082 FAX CELL EMAIL r S31ON M3IA3e1 Ndld #11 Wb3d $ :93d ❑ ❑ 1IW213d 3H1 Ski S3AH3S NOIlki011ddki SIHl oN seA S310N NOI103dSNI 1VNId JCINO 3Sf1 d0103dSNI 2103 30Vd SIHI S310N NO1103dSNI SVO HOf102i