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HomeMy WebLinkAboutBLDG-22-002214 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e� CITY YARMOUTH MA DATE October 19,2021 PERMIT# BLDG-22-002214 if JOBSITE ADDRESS 31 KENNEDY LN OWNER'S NAME KRUMINS VALDIS I CO-TRS G OWNER ADDRESS CIO NIKULA ROBERT R 31 KENNEDY LN WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Ei RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES 0 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 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 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 El 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 Alex Braga LICENSE# 15668 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME: BRAGA BROTHERS HEATING,PLUMBING ADDRESS. 110 Breeds Hill Rd,Unit 5, CITY Hyannis STATE MA ZIP 02601 TEL 5088274260 FAX CELL 7744870199 EMAIL bragabrosna,comcast.net ShcON M31A32!NVId #111/213d $ 33d ❑ ❑ 111*13d 3H1 SV S3A213S NOIIV3IlddV SIH1 oN saA S310N NO1103dSNI 1VNId AINO 3S18O103dSNI iJ03 3OVd SIH1 S310N NO1103dSNl SVO HDflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK h � ; CITY i Town of Yarmouth MA DATE 10/13/2021 PERMIT µ -2_1 - Z Z { • JOBSITE ADDRESS 31 Kennedy Lane OWNER'S NAME Ryan Nikula i OWNER ADDRESS 31 Kennedy Lane TEt ]FAX[ - TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT i RESIDENTIAL X CLEARLY NEW: RENOVATION: X REPLACEMENT: PLANS SUBMITTED: YES ( NO X APPLIANCES Z FLOORS--. BS v1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER --- CONVERSION BURNER —_ COOK STOVE -- DIRECT VENT HEATER j DRYER FIREPLACE FRYOLATOR I } FURNACE 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS _- 1 MAKEUP AIR UNIT ____- �-- - � --•--- _ i _._ . _-._ __ � OVEN _ POOL HEATER - ROOM / SPACE HEATER ROOF TOP UNIT V._ TEST UNIT HEATER - WATER UNVENTED ROOM HEATER I- } WATER HEATER 1 OTHER-� --------}-- -----. � _ _ _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 1 f NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY • OTHER TYPE INDEMNITY BOND U 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 a • rc o the b of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ith Pe ier .ir ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. % PLUMBER-GASFITTER NAME ALEX BRAGA J LICENSE # 15668 ��,, 1GNATURE P JGF LPGII CORPORATION ' �# 3618 t 1 MP � ,-; 11GF ; PARTNERSHIP _�# � LLC � # COMPANY NAME: BRAGA BROS. INC, I ADDRESS 110 BREEDS HILL ROAD UNIT 5 J CITY HYANNIS ...__ STATE MA j ZIP 02601 ITEL (508) 827-4260 J FAX 508 957-2960 I CELL 774 487-0199 IEMAIL bragabros@comcast.net