HomeMy WebLinkAboutG-13-899 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
} -• CITY Yarmouth MA DATE 3/28/13 PERMIT# &(3---eq9
JOBSITE ADDRESS: 261 & 263 Old Town House Road (West Yarmouth) M#86/P#22 OWNER'S NAME: KREC LLC
GOWNER ADDRRESS: 10 Atlantic Avenue South Yarmouth MA 02664 TEL:_ FAX
TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONAL RESIDENTIAL El
PRINT ❑
CLEARLY NEW:0 RENOVATION: 0 REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO❑
APPLIANCES? FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10• 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE 2.
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR . .. - -
FURNACE 2
GENERATOR —
GRILLE
INFRARED HEATER -
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN �IIty, ,9
POOL HEATER IC/
ROOM / SPACt HEA1ER DCCE�E
ROOF TOP UNIT
ZEST dlli "
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER I. '
OTHER
IN URANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES XLI NO ❑
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 all of the details and information I have submitted or entered regarding this application are true and acc rate to the •- of my knowledge and that'
all plumbing work and installations performed under the permit issued for this application will be in compliance wit - •- in-S •rovis'• of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws..
PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M ' 'NATURE
MP ® MGFD JP ❑ JGF 0 LPG! 0 CORPORATION ® #2803 PARTNER HIP ❑# LLC 0#
COMPANY NAME Hall , Plumbing & Heating, Inc. ADDRESS 447 Old Ch94rdo Riled, fl ��
CITY South Dennis STATE MA ZIP 02660 TEL 508-385-9127 IU `� 6 I!- 1I
FAX 508-385-6604 CELL EMAIL HafTechnidanecomcast.net APR 2013 D
IDY � _,_
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#
PLAN REVIEW NOTES
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