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HomeMy WebLinkAboutG-13-730 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK CITY : Yarmouth LMA DATE 1/31/13 PERMIT# 12/1— 735- JOBSITE ADDRESS: 15 Sharon Road (South Yarmouth) M#69 P#79/PID#9029 OWNER'S NAME: Kathleen Phillips GOWNER ADDRESS: Same TEL I FAX TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONALRESIDENTIAL PRINT ❑ 0 CLEARLY NEW: 0 RENOVATION: 0 REPLACEMENT: in PLANS SUBMITTED: YES D NO❑ APPLIANCES 1 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 ` UI NAGE . GENERATOR GRILLE • INFRARED HEATER LABORATORY COCKS "MAKEUP-AIR UNIT OVEN _ POOL HEATER ACCEPTED / ROOM / SPACE HEATER . � �� ROOF TOP UNI f • sr, % , 2 /3 1151 • . UNIT HEATER . UNVENTED ROOM HEATER ' WATER HEAlER ' OTHER INSURAN E COVERAG I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 , YES © 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: • •' = 0 AGENT 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 an. • . - . I e be •I my knowledge and thai all plumbing work and installations performed under the permit issued for this application will be in compliance ; •- u r • • the / Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030•M .r•TUBE ,•'' MP ® MGF❑ JP 0 JGF 0 LPGI o CORPORATION ® #2803 . PARTNERSHIP ■ • LLC p# COMPANY NAME Hall Plumbing & • Heating, Inc; ADDRESS 447 Old C Ati amE got 1 U t J D CITY_South Dennis STATE MA ZIP 02660 TEL 508-385-9127 . 17 FAX 508-385-6604 CELL EMAIL HallTechnicianPcomcastne JU( F 8 0t//4 2013 -•/ BUI DI{NGQEPTS� By _ • 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 • 1 01' IMI C] C7 I'-. .. . { t _ I!