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HomeMy WebLinkAboutG-14-379 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK \ -1 CITY Yarmouth MA DATE 10/07/13 PERMIT# b/9'e- 1 3l7 JOBSITE ADDRESS 9 Camelot Road(Yarmouthport) M#132/P#107 OWNER'S NAME: Sanborn GOWNER ADDRESS SAME TEL 508-847-3842 FAX TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONALRESIDENTIAL Ei PRINT ❑ 0 CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: ® PLANS SUBMITTED: YES ❑ NOD APPLIANCES 7 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 i DRYER t . FIREPLACE FRYOLATOR "FURNACE —1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS "f`KAKzUnlRT IT OVEN POOL HEATER ROOM / SPACE HEATER `1 /W ,, ROOF TOP UNIT j,CCIPTED IESf . UNIT HEATER 6L UNVENTED ROOM HEATER WATER HEATER II OTHER ��(`,� ,v E Obi. 93 - IN _ INWRANCECO a I have a torr-•t li ' T`r.f .- substantial equivalent which meets the requirements of MGL.Ch.142 YES © NO ❑ IF YOU CHEC D3.1 1 E INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW __ LIABILITY INSURANCE POUCY ® OTHER TYPE INDEMNITY 0 BOND 0 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 0 AGENT 0 ' SIGNATURE OF OWNER OR AGENT ere•yce I a a o se., avesu• it'or en , -. rega •Ing I isapp icabon are ean• ra : • h•-- 0 • ^•'ge an. i a all plumbing work and installations performed under the permit Issued for this application will be in compliance wi t • di - provision • the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-Mpra NATURE MP [ MGF❑ JP EJJGF ❑ LPGI ❑ CORPORATION ® #2803 ARTNE-• • LLC 0# COMPANY NAME Hall Plumbing & Heating, Inc, ADDRESS 447 Old Chatham Road CITY South Dennis STATE M ZIP 02660 TEL 508-385-9127 FAX 508-385-6604 CELL EMAIL HaIlTechnician(rDcomcast.net Aeff 4.4 r SHION M3IA 111/%1N/1d #11WM d $ :33d ❑ ❑ 1JW1:13d 3H1 SV S3AM3S NOI1V3Ilddy SIHl oN SaA S31014 NOLL73dSNI 7VNI3 AINO 3S11 ZIO.L33dSNI NOd 30Vd Slat S3ION NOI.LD3dSN1 SVO H91101I .r• .