HomeMy WebLinkAboutG-13-958 •
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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MA ��s�/ DATE: l/ �/3 PERMIT# '/
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JOBSITE DRESS:36 A (I NGA ` i OWNER'S NAME: FTezGc_. \7t o" ;pail/
GOWNER ADDRESS: TEL FAX:
TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL®-----
PRINT
CLEARLY NEW:0 RENOVATION:[REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO,Z—
APPLIANCES? FLOOR I Bsmt 1 2 1 3 1 4 5 6 1 7 8 9 10 11 12 13 1 14_
BOILER _
BOOSTER _
CONVERSION BURNER
COOK STOVE I
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE I I –
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCK I _
MAKEUP AIR UNIT
OVEN
POOL HEATER _ _
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER -
cUNVENTED ROOM HEATER
WATER HEATER /
stINSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES/fat-Ell]
If you have checked YES please indicate the type of coverage b ecking the appropriate box below.
LBIL INSURANCE POLICY . OTHER TYPE INDEMNITY 0 BOND 0
OWNER'S INSURANCE W
AVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
cMassachusetts General Laws,and that my signature on this permit application waives this requirement
CHECK ONE ONLY: OWNER 0 AGENT 0
OSIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and a 7 rata • II" best of m
Knowledge and that all plumbing work and installations performed under the permit issued for this application tar e ent
provision of the Massachusetts State Plumbing Code and
Chapt r 142 of the General Laws. �/ •win:PLUMBERJGASFTTTERNAMEI � r,P•c �I� LICENSE# 0• �i SIG !:''Et
COMP NAME: i�aui kVA, ( ADDRESS: /0.77 '' 0
CIN /4yl•S LS MactiS STATE: rN k` ZIP:O26 %1 FAX
TEL:6 od--IP2 ( j3 CELL Sad-533&-ood'tMAIL: M l06, 3 f�� ((�� ® m-5vu`t(O -1--
MASTER
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MASTERRNEYMAN 0 LP INSTALLER 0 CORPORATION❑# PAIj�'tERS:-IIP Ol 1I 1? (ir.r❑
LPR 24 2013 L •
•
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes Na
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT@
PLAN REVIEW NOTES
of TOWN OF YARMOUTH Building Department BUILDING
ite
d .t, PERMIT NO F6-13-891- • (508) 398-2231 ext.1261
ISSUE DATE ; 12/31/2012 PROPOSED USE PERMIT
APPLICANT 'Lawrence I Karen Pucciarelil- - - - - - - - - - -; JOB WEATHER CARD
PERMIT TO ; Addition
AT(LOCATION) 0036SALT MARSH LN ZONING DISTRICT R-25 Bldg.Type: Residential
SUBDIVISION MAP LOT BLOCK 017.115 BUILDING IS TO BE: CONST TYPE 5-8 USE GROUP R-3
LOT SIZE
CONTRACTOR
construct 6 x 9 addition as per plans dated 12/20/12. LICENSE
ICENSE
AREA(SO FT) EST COST($ $20,000.00 PERMIT FEE($) $300.00
OWNER Lawrence&Karen Pucclarelli BUILDING DEPT BY
ADDRESS 362 Forest Ave
Middleton RI 02642 PHONE 4016621517
INSPECTION RECORD FIELD COPY
Date /�y� N�otJe Progress-Corrections and Remarks Inspector
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