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HomeMy WebLinkAboutBLDG-22-004661 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �"' �� CITY YARMOUTH MA DATE February 23,2022 PERMIT# BLDG-22-004661 _ JOBSITE ADDRESS 50 BENJAMIN WAY OWNER'S NAME HAMILTON THOMAS G OWNER ADDRESS HAMILTON SUSAN M 50 BENJAMIN WAY WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS-4 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 1 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 Virgilio Silva LICENSE# 31395 SIGNATURE MP❑ MGF ❑ JP© JGF❑ LPG! 0 CORPORATION 0# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: VIRGILIO SILVA ADDRESS. 155 SUDBURY LN, CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL viruiliomga(aahotmail.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 "— = ; HUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k.-__= - .v, C E I1971 t't CITY armouth MA DATE 02/22/22 PERMIT# -1 1_ �w,i ° - EB 22 2022 JOBSITE ADDP,ES 3 50 Benjamin Way OWNER'S NAME Ken Lafrennie ek DING NE" Nl A 50 Benjamin Way OI pi J TEL FAX _ TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL ❑ RESIDENTIAL Ei PRINT CLEARLY NEW:0 RENOVATION:LI REPLACEMENT:U PLANS SUBMITTED: YES 0 NO Q APPLIANCES 1 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER �i _ i _ :I � BOOSTER CONVERSION BURNER __ COOK STOVE DIRECT VENT HEATER I ! i DRYER L 1 , I, _ ! °, FIREPLACE FRYOLATOR I 1 FURNACE GENERATOR GRILLE 1 ! , ! I i INFRARED HEATER J .j 11 1j LABORATORY COCKS I. MAKEUP AIR UNIT ' OVEN I POOL HEATER I- - ti ROOM I SPACE HEATER ROOF TOP UNIT [ ! j .- y , 1 TEST I 1 i 1 _ _ __ __ _ UNIT HEATER UNVENTED ROOM HEATER g ! 1 WATER HEATER L _ _ i OTHER t INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO U I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY 0 BOND El 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 0 AGENT 0 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 • • • o my n' •ge and that all plumbing work and installations performed under the permit issued for this application will be in compliance . Pertinent prov' •. • th Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Virgilio Silva LICENSE#31395-J SIGNA IRE MP D MGF LJ JP[0 JGF El LPG'0 CORPORATION E# ' PARTNERSHIP 0# LLC # j COMPANY NAME ilea Plumbing&Heating ADDRESS 155 Sudbury lane CITY Hyannis STATE MA ZIP)2602 TEL FAX ' CELL7748360276 EMAIL virgiliomga@hotmaii.com