HomeMy WebLinkAboutBLDG-17-005631 t-`-
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
Tit; CITY (Yarmouth -- 1 MA DATE4/20/17 I PERMIT it j /,A--)/ 512 51
JOBSITE ADDRESS 22 West Woods 1 OWNER'S NAME [Tropsa 3
GOWNER ADDRESS I T osa TEI�508 -237-6839 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL El
PRINT
CLEARLY NEW: , RENOVATION:!_ 1 REPLACEMENT: 9 PLANS SUBMITTED: YES❑ NOD
APPLIANCES 2 FLOORS–. 8SM 1 2 3 4 5 6 78 9 10 11 12 13 14
BOILER :
BOOSTER
CONVERSION BURNER +y
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
.._
FURNACE 1 —
GENERATOR ` -
GRILLE 1
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER w•
ROOMISPACEHEATER
ROOF TOP UNIT re _
TEST «. ' -W r
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER T-
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO C
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY �,;,,q OTHER TYPE 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.
CHECK ONE ONLY: OWNER ❑ 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 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 ..mpliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME James Papasodero LICENSE#(M 7-82 SIGNATURE
MP 0 MGF El JP ED JGF[j LPG!(J CORPORATION Wit LC171 PAR SHIP E.:3 tit 1 LLC❑#�
COMPANY NAME:ARS/Heatin9&NC Services – 1 ADDRESS 1300 Manley St j
CITY I W.Bridgewater J STATE[MJZIPI02379_JTEL 508-588-9025
FAX 508-588-1059 CELL r
IEMAILI�_,__�
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