HomeMy WebLinkAboutBLDG-19-002581 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
-W1= CITY Yarmouth MA DATE 1012212018 PERMIT#/44*7'2-CVIZ '
JOBSITE ADDRESS 13 MacKenzie Rd OWNER'S NAME Bryson I Colina
GOWNER ADDRESS Bryson I Colina TEL FAX
PPE O R
OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL D
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:D PLANS SUBMITTED: YES❑ NO D
APPLIANCES 1 FLOORS—, ESM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER 10.11111IMENUOSIMIUSEMINCSIONINSIMMINE
COOK STOVE f E
CONVERSION BURNER *: �
llitillaiignitia
DIRECT VENT HEATER
DRYER d
FIREPLACE
FRYOLATORFU
GENERATOR
WOOMIUMIIIMUSSMINUMOOMIWMIONIUMMUNIE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT S �rn0 IZ111 '
OVEN
POOL HEATER ��
ROOM I SPACE HEATER _' S SI**If1 tatai *WS'
ROOF TOP UNIT
TESTBassi SSIItt. .Ct=ii fallia
UNIT HEATER —ssssssSIZrONs'st��iguns
UNVENTED ROOM HEATER sssss!�ssssssss{�I�
WATER HEATER
OTHER slsssssssissrslsss5
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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 LINO ❑
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 pennit 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 compli-••:wi I P ro - on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � -
PLUMBER-GASFITTER NAME Peter J.Hassett LICENSE# 11682 SIGNAT RE
MP Q MOF❑ JP❑ JGF❑ LPG!❑ CORPORATION D# 3506 I PARTNERSHIP❑# LLC❑#
COMPANY NAME: Hassett Plumbing and Heating Inc. I ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555
FAX I CELL 508-237-2175 EMAIL peterjhassett@ mail.com
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