HomeMy WebLinkAboutG-19-2740 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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Ni= CITY Yarmouth Port MA DATE 11/5/2018 PERMIT#/5Wk/yam..7 0d•270`�
JOBSITE ADDRESS 79 Homestead lane OWNER'S NAME Nate Weeks
GOWNER ADDRESS "same" TEL 508-364-0687 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL❑ RESIDENTIALD '
PRINT J-r-zy s o al
CLEARLY NEW:D RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NOD
APPLIANCES Z FLOORS- • BSM 1 2 3 4 5 6 . 7 6 ' 9 10 11 12 13 14
BOILER
BOOSTER 1 I 'I k il I I'
CONVERSION BURNER • I 1 I. I I i 1 (
COOK STOVE `
DIRECT VENT HEATER I I I I
DRYER I I I I P
FIREPLACE I - 1 1
FRYOLATOR I 1' G ' ' I; I I
FURNACE I I r r I 9 I 7 1 I I'
GENERATOR 1
GRILLE I 7 -I -P I
INFRARED HEATER i.
LABORATORY COCKS _ I I — _
MAKEUP AIR UNIT I I I ; I I I _ M '
OVEN I I I. II 1. ; a EI iii! ,1 '
POOL HEATER - I I I 1 '
ROOM/SPACE HEATER . • I I I I
ROOF TOP UNIT 1 I I It- I N #1 I I -- -
TEST
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UNIT HEATER • i I - if I— 7 ;li• PAR MEN
UNVENTED ROOM HEATER I 6 I' I' I her. Ii --•—
WATER HEATER I
OTHER I 11- { I: li I
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INSURANCE COVERAGE
I have a current;lability Insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 . YES D NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY E 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 pennit application waives this requirement
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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 compli awith all P hent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �J
PLUMBER-GASFITTER NAME James Wahtola LICENSE#12. r1 SIGNATURE
MP❑ MGF❑ JP D JGF Q LPGI❑ CORPORATION❑# PARTNERSHIP CIO LLC❑#
. COMPANY NAME:Wahtola Plumbing and Heating ADDRESS 24 Plant road unit 7
CITY Hyannis • STATE MA ZIP 02601 TEL 508-778-6868
FAX 508-862-2129 CELL 508-294-5273 EMAIL office@wahtola.com
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT El ❑ --))
FEE: $ PERMIT# C/u
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PLAN REVIEW NOTES /z(-