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HomeMy WebLinkAboutBLDG-23-005245 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ................... _ y; CITY YARMOUTH MA DATE March 23,2023 PERMIT# BLDG-23-005245 f JOBSITE ADDRESS 579 BUCK ISLAND RD OWNER'S NAME TURINO ASSOCIATES LLC G OWNER ADDRESS 2000 COMMONWEALTH AVE AUBURNDALE MA 02466 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL Q RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:m PLANS SUBMITTED:YES m NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 4 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 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 El 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 Eric Roy LICENSE# 16241 j SIGNATURE MP© MGF❑JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑#I ILC ❑# COMPANY NAME ERIC R ROY ADDRESS. 218 PLAIN STREET, CITY TAUNTON STATE MA ZIP 02780-4972 TEL FAX CELL EMAIL • -,n "`_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "k- 32323 Z3-0OSZY. - _� CITY: Yarmouth MA. DATE / / IT — Jpg�E ADORES 579 Buck Island Road ow NAME 1t?r,lnil ASS 3 k S L�.c_ G OWNER ADDRESS: acoo L,43c:(`0)Q. TEL: FAX: Ak-kwTYPE OR OCCUPANCY TYPE tMERCIAL ►o'L�lc,� EDUCATIONAL 0 RESTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:IA PLANS SUBMITTED: YES❑ NO Ed APPLIANCES7. FLOOR.-4' Ban 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 7 y BOOSTER CONVERSION BURNER ` COOK STOVE DIRECT VENT HEATER DRYER _ FIREPLACE — _FRYOIATOR FURNACE _ _ _ GENERATOR ,, GRILLE kii .INFRAREL1 HEATER - - Lu V LABORATORY COCK ' MAKEUP AIR UNIT . ,_ . �l OVEN POOL HEATEI ROORMRia HEATER J UNIT TOP Y _ , TEST _ _ UNIT HEATER _ r 4.1 UNVENTED RO 1 HEATER _ _ WATER HEATER IJ t1RANCE COVERAGE - - I have a currant jiabllity mstRance policy or its substantial equivalent which meets the requirements of MGL( h.142 YES ® NO 0 If you have checked US,please hdlcate the hype of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY © OTHER TYPE INDE*ITY 0 BOIL ❑ 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 it iv this requirement. CHECK ONE ONLY: OWNER ® AGENT ❑ SIGNATURE OF OWNER OR A3EN f hereby malty that all of the details and Woman I have submitted(or entered)regarding this implication are true and accurate to the best of my Knowledge and theta!!ptentig work and ins perfumed under the permit Issued for this application will be M. ..:with all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 ditto General Laws./ PLUMBEi/CASE-117ER NAME: trl c. 20� UCBNSE#/( 2u I I /TUBE compANy NAME Roy and Pacheco Mechanical ADDRESS: 105 Pratt Street CITY: Mansfield STATE: MA Di,: 02048 FAX: TEL , _ cELL 774-266-3280 EMAIL' MASTER 0 JOURNEYMAN 0 LP INSTALLER❑ CORPORATION❑# PARTNERSHIP❑# LLC®#56-2460788 c iri'hi c, �,37 ss: brr-oY S ID P,16thop J-47IN