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HomeMy WebLinkAboutG-13-704 tt/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CIN Yarmouth • MA DATE 1125113 PERMIT# I'M7oy JOBSITE ADDRESS: 38 Early Red Berry Lane (Yarmouth Port) M#115 IP#190 OWNER'S NAME: Nancy Pendleton GOWNER ADDRESS SAME TEL 1 FAX TP NOR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL El CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:® PLANS SUBMITTED: YES 0 NO p 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 DRYER • , FIREPLACE ' FRYOLATOR 11 "FURFJAtE j ' GENERATOR . -D t GRILLE li '2913 INFRARED HEATER LABORATORY COCKS rim '1:XG C'PT •T1IATCEUPWR NIT , By OVEN . POOL HEATER., ROOM-I SPACE HEATER ... ROOF TOP UNIT 1151 ACCEPTED UNIT HEATER r In I • "Int •y. s//areA 1/' WATER HEATER OTHER . INSURANCE COVERAGE I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES © 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. I ' CHECK ONE ONLY: OWNER • • ENT 0 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 a••• r t. . 'best of my kn• >.ge and that all plumbing work and installations performed under the permit issued for this application will be in compliance w • . Pe ;r t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M NAT MP ® MGFD JPO JGF 0 LPGI 0 CORPORATION ® #2803 P:• ER 'IP D# LLC ❑# COMPANY NAME Hall Plumbing & Heating, Inc, ADDRESS 44 old Chatham Road CITY_South Dennis STATE MA ZIP 02660 TEL 508-385-9127 FAX 508-385-6604 CELL EMAIL ' HallTechnician(aeomcastnet ' ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY • FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE $ PERMIT/ i .. - — PLAN REVIEW NOTES • irt t. • • • • r