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Home My WebLink AboutBLDG-22-004660 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH I MA DATE February 23,2022 PERMIT# BLDG-22-004660 Fi JOBSITE ADDRESS 19 CRANBERRY LN OWNER'S NAME TAREK WISSAM R G OWNER ADDRESS 19 CRANBERRY LN SOUTH YARMOUTH MA 02664 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 HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 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 Massaci usetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva LICENSE# 31395 SIGNATURE MP❑ MGF ❑ JP 0 JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX —1 CELL EMAIL virgiliomcahotmail.com S310N M3IA38 NVId #111Aa3d $ 33d ❑ ❑ 111Nd3d 3H1 SV S3/W3S NOI1V3IlddV SIHl ON SOA S310N N01103dSNI 1VNId AINO 3Sfl N0103dSNI d0d 30Vd SIHI S310N NO1103dSNI SVO HJfOa r- - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ijCEiVEDI 1, CITY-Ya o MA DATE)2/21/22 'PERMIT # -2 2- - Lt (oG `- TEB `' ? 6� 11 ADDRESS 19 Cranberry Lane OWNER'S NAME Sam Tarek U DING E6 ft ADDRE S Franberry Lane TEL FAX I 3y , `_r _ • • PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW:Li RENOVATION: REPLACEMENT: L., PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS--. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER • 1 CONVERSION BURNER COOK STOVE DIRECT VENT HEATER .. , DRYER UMW Ifr ,;.-. ., . —4=----. FIREPLACE '' FRYOLATOR FURNACE --- - _ � - - .. , - GENERATOR GRILLE . _fir` INFRARED HEATER /, ' ,r _ .. LABORATORY COCKS MAKEUP AIR UNIT ' _ l ° �- _:j..t OVEN [ , - ,, �_N_ POOL HEATER 1 ' ROOM / SPACE HEATER ' L. ROOF TOP UNIT I _.. ,. ;. TEST �___ 1 - -- _ !y-� UNIT HEATER _i r UNVENTED ROOM HEATER I--- WATER HEATER OTHER ..�. ..� �.... --, 11 1 _ 4.. , r__. IL_ , .____ INSURANCE COVERAGE I have a current liability_insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [J NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 12 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 AGENT 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 Perti Massachusetts State Plumbing Code and Chapter 142 of the General Laws. — PLUMBER-GASFITTER NAME Virgilio Silva ILICENSE #31395-J f MP ID MGF JP 4.- JGF Li LPGI CORPORATION ®# r PARTNERSHIP # LLC # M." ilva Plumbing & Heating155 Sudburylane COMPANY NAME ADDRESS CITY 'Hyannis STATE MA I Z I P 02601 TEL FAX I I CELLr748360176-1EMAILgiliomga@hotmail.com