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HomeMy WebLinkAboutBLDG-22-002803 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -_ i CITY YARMOUTH tl MA DATE November 16,2021 PERMIT# BLDG-22-002803 JOBSITE ADDRESS 43 HEADWATERS DR OWNER'S NAME Luis Mattos G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El 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 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND 0 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 Virgilio Silva LICENSE# 31395 SIGNATURE MP 0 MGF 0 JP 0 JGF 0 LPG! 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# _ COMPANY NAME: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomga4hotmail.com S310N M31A3H NVId #11Wii3d $:33d ❑ ❑ 11Wa3d 3H1 SV S3AH3S NOI LVOIlddV SIHl oN saA S31ON NO1103dSNI 1VNId AINO 3SIl 210103dSNI HOd 30Vd SIHl S31ON N01103dSNI SVO HOflOH MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k, $ CITY Yarmouth MA DATE 11/12/21 IPERMIT # 22 - JOBSITE ADDRESS 43 Headwaters Dr. OWNER'S NAME p_uis Felipe Mattos J G .._,. OWNER ADDRESS 43 Headwaters Dr. TEL qF ((I V E D.j TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDEN IA(�7 PRINT -NOV i 2 2021 CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SIJB4ITTED: YES . NOD APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 : :_._l.L—_-i -.2 _ 14 BOILER 1111111 - - __ -�.-- '' .7---- - BOOSTER 11111.11111111M CONVERSION BURNER _ ---- _ COOK STOVE - 1.11 - DIRECT VENT HEATER _IL DRYER - r- FIREPLACE 111111M1111. _ FRYOLATOR ;1 i r , FURNACE 1 GENERATOR r-.. r GRILLE i -tr INFRARED HEATER11111111111111...1111.111.11WENUIPPW LABORATORY COCKS MAKEUP AIR UNIT y OVEN POOL HEATER ROOM / SPACE HEATER i _� _ ROOF TOP UNIT _ . 1 i M 4 TEST 1111.1111111111. --- _ -- UNIT HEATER UNVENTED ROOM HEATER 'MMIMIMMIMIl WATER HEATER ' 11111111.111111.1 OTHER 11.11111 _" ______. _ 1 i MUM INSURANCE COVERAGE I have a current Iiabilit�Linsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 12 NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW j LIABILITY INSURANCE POLICY , OTHER TYPE INDEMNITY . BOND Li 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 ccurate to the best of my knooedge and that all plumbing work and installations performed under the permit issued for this application will be in co visi the '-- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME IVirgilio Silva I LICENSE 4-1395 SIGNATURE MP 0 MGF JP D JGF D LPGI CORPORATION ®# I-- _-1 PARTNERSHIP©#T I LLC D# 1 COMPANY NAME:Silva Plumbing &n Heating ADDRESS 155 Sudbury lane CITY 'Hyannis STATE MA ZIP 2601 TEL ' 1 7748360176 EMAIL virgiliomga@hotmail.com FAX __; CELL