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HomeMy WebLinkAboutBLDG-22-006125 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK VIr"" CITY YARMOUTH MA DATE April25,2022 PERMIT# BLDG-22-006125 JOBSITE ADDRESS 2 FIRST RD OWNER'S NAME IMURTHY KOLLEGAL S G OWNER ADDRESS MURTHY HELENE 82 NORTHFIELD RD LONGMEADOW MA 01106 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT❑ 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 1 DIRECT VENT HEATER DRYER FIREPLACE 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 0 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 Ronald Bizzozero LICENSE# 10006 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI 0 CORPORATION❑# PARTNERSHIP ❑# -Inc❑# COMPANY NAME: RONALD P BIZZOZERO ADDRESS. 114 STETSON RD, CITY INORWELL I STATE MA ZIP 020612822 TEL FAX CELL EMAIL none S310N M3IA3H NVId #.IIN2:13d $ :333 ❑ ❑ 111A1d3d 3H1 SV S3A213S NOLLVOIlddd SIHI oN saA S3lON NOI103dSNI 1VNH )llNO 3Sf 1010adSNI 2103 3OVd SIR! S31ON NOI103dSNI SVO HOfOd MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: 7 wA-earvk ram'TVAMA. DATE: ‘-1• PERMIT# 'L2 12- Ic- JOBSITE ADDRESS: Z ►R S ''a"› OWNER'S NAME:N1%%4'-T1-ic'E GOWNER ADDRESS: 7-(:- f-A TEL: FAX: TYPE OR L e NC- �h-�..:1 dvlra O i10 PRINT OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-1 FLOOR-, Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE / DIRECT VENT HEATER DRYER ( ( f I I FIREPLACE 1I FRYOLATOR 1 FURNACE GENERATOR GRILLE v) INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER -.I ROOF TOP UNIT fi TEST .: UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 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 have checked YES,please Indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 0' OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee doles 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 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 appllcati n will be In compliance with all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. 1 ��'�4 - PLUMBER/GASFITTER NAME: be-- LICENSE# I'CcO,e SIGNA 1 / COMPANY NAME:gi, F-z-aye SLO i LL)1 1zi k)C.--_. te 1 ADDRESS: )l �-t S -\ i / CITY: 1�= -L � _ STATE: 1W14 ZIP: CI70(`` FAX: TEL:77)"FL —gi O� CELL t-k l— 2�3f ? `c'7 EMAIL: fit'' V'`>r.-Z G—tL1 i - MASTER[JOURNEYMAN❑ LP INSTALLER El CORPORATION V,#;5 L 7 PARTNERSHIP❑# LLC❑# Eh /9,c. ADDzesS 111y - --- -- • • • • • • •