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HomeMy WebLinkAboutBLDG-22-006140 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1i_1 CITY YARMOUTH MA DATE IApnl26,2022 (PERMIT# BLDG-22-006140 JOBSITE ADDRESS LELLIS CIR OWNERS NAME MERINO DONALD G OWNER ADDRESS MERINO ROSEMARIE 19 PETER LYNAS CT TENAFLY NJ 07670-1115 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 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 1 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 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 ❑ 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 Matthew Scioletti LICENSE 27041 SIGNATURE MP 0 MGF❑JP Q JGF❑ LPG(❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: SCIOLETTI PLUMBING ADDRESS, 58 Townhouse Ter, CITY Hyannis STATE MA ZIP 02601 J TEL 7748100292 FAX CELL EMAIL S31ON MRIA321 NVId #1I W213d $ :333 ❑ ❑ lIW2I3d 31-1.SV S3A213S NOIiVOIlddV SIH. oN seA S310N NO11O3dSNI lVNI3 AINO 3Sfl 80103dSNI HOd 3OVd SIHI S310N NOI103dSNI SVJ 11011021