HomeMy WebLinkAboutG-14-285 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORKC 0
CITY Yarmouth
x MA DATE 09/20/13 PERMIT# bi7 a
JOBSITE ADDRESS 14 Cedar Street(South Yarmouth) M#34 I P# 180 OWNER'S NAME Ayoub
GOWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONALRESIDENTIAL El
PRINT ❑ 0
CLEARLY NEW:0 RENOVATION: 0 REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO D
APPLIANCES 1 FLOORS BSM 1 2 3 _ 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE I .
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
TTERME
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS _ B E g ii g \j R ITy ,.
1 REOPAIRUNIT
OVEN • cry > `7 i In 1.-1
POOL HEATER
ROOM / SPACE HEATER ,
ROOF TOP UNIT CU's P'«
lig 44/P,
IESI � ���ro
UNIT HEATER
UNVENTED ROOM HEATER .
WATER HEATER RC CE' ; ) 1/47/5
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES in NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ® 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 ❑
SIGNATURE OF OWNER OR AGENT . ��,��
I hereby certify that an of the details and information I have submitted or entered regarding this application are true and a_�tanlJ 1. .-st of my • owledge and that
all plumbing work and installations performed under the permit issued for this application will be in compliance ' •rovision of e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M V - -.:..URE
MP ® MGFD JP D JGF ❑ LPG! ❑ CORPORATION ® #2803 * r NE' HIP ❑# LLC ❑#
COMPANY NAME Hall Plumbing 8 Heating, Inc, ADDRESS : r Chatham Road
CITY South Dennis STATE MA ZIP 02660 TEL 508-385-9127
FAX 508-385-6604 ' CELL EMAIL HallTechnicianecomcast.net
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No I✓ W\N-rc (2-1-P.51
THIS APPLICATION SERVES AS THE PERMIT 0 0
CiN Q., sv7' -t'tInuvrr((,
FEE: $ PERMIT# Wf7CdcL wool No
PLAN REVIEW NOTES -rTl(✓yJ a
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