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HomeMy WebLinkAboutBLDG-22-004390 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `111'111' CITY YARMOUTH MA DATE February 08,2022 PERMIT# BLDG-22-004390 JOBSITE ADDRESS 60 CAPT LOTHROP RD OWNERS NAME BAILEY JANET M(EST OF) G OWNER ADDRESS CIO EDWIN BAILEY P 0 BOX 704 E SANDWICH MA 02537 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: 0 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 DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 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 0 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 IVirgilio Silva I LICENSE# 131395 SIGNATURE MP 0 MGF 0 JP© JGF❑ LPGI ❑ CORPORATION❑#I PARTNERSHIP ❑# LLC ❑# COMPANY NAME: VIRGILIO SILVA ADDRESS. 1155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 1026012462 TEL I FAX I I CELL I I EMAIL Ivirgiliomga(fD,hotmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -�r CITY Yarmouth �u�l�y� I MA DATE 02I07/2022 'Z 2- `13�0 PERMIT# JOBSITE ADDRESS SO Captain Lothrop RD. OWNER'S NAME Pereira Wanderson GOWNER ADDRESS 432 Old Chatham Rd. TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[1 EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:Q RENOVATION:® REPLACEMENT:U PLANS SUBMITTED: YES U NO Q APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER �f CONVERSION BURNER COOK STOV DIRECT VEN HRT CA VE DRYER FIREPLACE FEB 07 2022 FRYOLATOR f[ ' ', ' ', FURNACE _. GENERATOR B ' • GRILLE at__---J-- V_ _ w 'i � , �INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN ., POOL HEATER 1 ROOM/SPACE HEATER ! ROOF TOP UNIT TEST UNIT HEATER — I-_m v _ >> . ,r m - UNVENTED ROOM HEATER WATER HEATER .. I OTHER -INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY LI BOND ID 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 LI 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 . 1. . ' . e o t et est o m ,owledge and that all plumbing work and installations performed under the permit issued for this application will be in • lance with all Pertinent pro : of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Virgilio Silva 31395-J PLUMBER-GASFITTER NAME g LICENSE# SIGNATURE MP LI MGF El JP 0 JGF LI LPGI LI CORPORATION 0# = PARTNERSHIP®#` LLC E]# 1 COMPANY NAMESilva Plumbing&Heating ADDRESS 155 Sudbury lane CITY Hyannis STATE MA ZIP)2601 TEL FAX CELL7748360176 EMAIL virgiliomga©hotmail.com