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Home My WebLink AboutBLDG-23-005391 #15 �.. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK in CITY YARMOUTH MA DATE March 30,2023 PERMIT# BLDG-23-005391 JOBSITE ADDRESS 15&17 ANGELOS RD OWNER'S NAME THOMPSON WILLIAM P G OWNER ADDRESS BROWN-THOMPSON MICHELLE A 17 ANGELOS RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 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 1 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 j 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 Paulo Demorais LICENSE# 15847 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: Paulo C.Demorais D/B/A SOS Heating&Coo ADDRESS. 235,Essex Street, CITY Whitman STATE MA ZIP 023821509 TEL 7813053319 FAX CELL EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES R "- E A V Iet$ ►CHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK < ; ''; -2 L C�(T,y;3/R rr7O U 7`7 MA. DATE./a f c2.N PERMIT# U[3 J i . _ JoBSITE Kama /S"/�/✓j-C/c7S /7,U. .3 OWNER'S NAME/n,Ch e�k koeri/,✓ - /.771/J �/ YU IL G � ADREss; 57�-- TEL:77Y- .�Ge- p7 FAX: TYPE ORT OCCUPANCY TYPE: COMMERCIAL 0 EDUCA 0 RESIDENTIAL crl PRINT � CLEARLY NEW;❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO N APPLIANCESZ FLOOR-4 Biwa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ r BOOSTER h CONVERSION BURNER .t COOK STOVE 'A.) DIRECT VENT HEATER _ DRYER _ _ FIREPLACE _ _ e FRYOLATOR vd ` FURNACE / k GENERATOR GRLLE _ V INFRARED HEATER _ _ W LABORATORY COCK MAKEUP AIR UNIT 4.4 4 OVEN • - POOL HEATER ROOM/SPACE HEATER NI ROOF TOP UNIT TEST • UNIT HEATER 14.1 UNVENTED ROOM HEATER WATER HEATER ,, INSURANCE COVERAGE I have a current liability knsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q'NO 0 a if you have checked yra,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER I am aware that the licensee doe 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 heresy certify that all of the details and hfonnation I have submitted(or entered)regards this application are true and accurate to the best of my Knowledge and that ail plumbing wait and Installations performed under the permit issued for this application MI be In compliance with all Pertinent provision of the Massachusetts Stattee Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: /:9cll ! m ice/ LICENSE#J 7 SIGNATURE COMPANY NAME U/Q� 21R'JS S//i4ttn j v— ADDRESS: /� �.L/.lh/i Si CITY:`a0.3,.n..� OoLSTATE: /r'IA- ZIP: '240/-3 1)7 FAX: Ta:/7/-_SOS -33/.7 CELL: __ E !,2?m thq j eth lies e4y44., .God MASTER 0 JOURNEYMAN 0 LP INSTALLER❑ CORPORATION PARTNERSHIP❑# L LC 0# 4 ProPtillYL c/ri c, 09,07.12e-ss: ,lac tr ,"ti-1.e MA't wo 4.gn y , e. r"')