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HomeMy WebLinkAboutBLDG-22-003444 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "" -6 CITY YARMOUTH MA DATE December 17,202'PERMIT# BLDG-22-003444 • JOBSITE ADDRESS 13 WILDFLOWER VILLAGE OWNER'S NAME CHRONIS JOHN C TRS G OWNER ADDRESS CHRONIS ANGELIKA B 1605 WINDING OAKS WAY APT 103 NAPLES FL 34109-0478 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL❑ PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO Q 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 I 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 ❑ OWNERS 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# ma SIGNATURE MP❑MGF❑JP 0 JGF El LPG! 0 CORPORATION❑#( PARTNERSHIP ❑# LLC❑# COMPANY NAME: Scioletti Plumbing and Heating ADDRESS. 58,townhouse ter,townhouse ter, CITY hvannis STATE MA ZIP 19_2601 TEL FAX CELL EMAIL S31ON M3IA321 NVId #IIIN213d $ :39A ❑ ❑ 1I0183d 3HI SV S3AN3S NOLLV3IlddV SIH1 oN sa), S3ION NO1103dSNI 1VN13 /LINO 3Sfl HO133dSNI 2HOd 39Vd SIH1 S310N NO1103dSNI SVO HOflO