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HomeMy WebLinkAboutG-19-1496 Ga,✓G Parra �_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK /�/ y(= CITY Yarmouth fri MA DATE 9/12/2018 PERMIT# /2.Ofr-/9-x0�%9/� JOBSITE ADDRESS 95 Witchwood Rd. OWNER'S NAME Silvino Dellorto GOWNER ADDRESS Silvino Dellorto TEL !FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 1 FLOORS-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1-1- . r I f 11-- — _f— I fI I— (— BOOSTER 1 11—'I I d .r— 1—. [—I I— CONVERSION BURNER I '1 I1 u I 1 I COOK STOVE iI i I 1 I I DIRECT VENT HEATER ,1 II r 1 I 1 DRYER I 'I ,I 1 I I ' I 1 II FIREPLACE 11 1 i I i 1 1 FRYOLATOR I 1 I I 1 1 iI ,I I f 1 1 I FURNACE I I-- I iI '1-1 !I I 1 I GENERATOR I I- 1 1 11 I I 1 GRILLE !1 1 'I iI .I hI :1—.1- 1 1 I ' INFRARED HEATER !I II 11 I it II it 1 I 1 1 I ' LABORATORY COCKS F y I I N N I1 I I I MAKEUP AIR UNIT I I 'I I I 1 1 I i I OVEN F I I (1 I I I I POOL HEATER I I I —1 1 I I ROOM I SPACE HEATER I 1 d I 1 1 I 1 I 1 I I ROOF TOP UNIT I 1 1 I 1 ,I , 1 1 1 I I 1 I I TEST I 1 I i_ UNIT HEATER I 11 I I 1 'i 1 lI I I I 1 I 1 I ' UNVENTED ROOM HEATER II I WATER HEATER y I ` I— I N N 1 I I I I 1 I OTHER Meter relocation l If I 11 11 ii I! ,I {I '1 L1 'I 7—.1 I I I I I I i 1-1 I( II 1 I r---f— i I i I I I 1 A i 1 11 '1 '1 - ,I J 1 I 11 1 1 I 1 f 1 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY 0 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 compl>a.: with�l�r•i , ,.y' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / ���i PLUMBER-GASFITTER NAME Peter J.Hassett LICENSE# 11682 SIGNATURE MP❑ MGF❑ JP❑ JGF❑ LPG(❑ CORPORATION Q# 3506 PARTNERSHIP❑# ac❑# 1 COMPANY NAME: Hassett Plumbing and Heating Inc. ADDRESS 18 Skipper Lane _ CITY Yarmouth Port STATE MA ZIP 02675 TEL 508x4 , ' E1 E_31 FAX CELL 508-237-2175 EMAIL peterjhassett©gmail.com • —SEP 12 2(}ta* I `J/rS 50—' JI/7