HomeMy WebLinkAboutG-14-321 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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p� JOBSITEADDRESS' 171yWendwardWa West Ya mouth __mi010103/13 •"„LL ;PERMIT# b��`✓�.�/
MA DATE
y OWNER'S NAME Mary Hartman
GOWNER ADDRESS L171 Wendward Way?West Yarmouth _. w_� ;TE4r413-662-2523 JFAXF- 1
TYPE OR
OCCUPANCY TYPE COMMERCIALL] EDUCATIONAL ill RESIDENTIAL L+'
PRINT
CLEARLY NEW:, ,) RENOVATION:'__,.) REPLACEMENT:L_! PLANS SUBMITTED: YES LI N0
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
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM I SPACE HEATER I ; , , -
ROOF TOP UNIT
TEST
UNIT HEATER
UNV TFf)Rom HFATC - - `
WATERomE E V t�
OTHER-;
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_ _ ._ Y q UR _... of MGL.Ch.142 YES (,�
BUILDINODEPP�j ENT” W INSURANCE COVERAGE Rn..
I have a%urrent-Ii bihi+# or its substantial equivalent which meets the requirementsNO
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY I..' OTHER TYPE INDEMNITY ;,_„1 BOND Li
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 i„,� AGENT L i
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 accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al P rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - •
PLUMBER-GASFITTER NAME r Kevin J SullivanLICENSE# 13041 1 SIG TURF
MP, ,1MGF;,_,,;JP Li JGFL_._a LPGI; _i CORPORATION !'#:2433 ;PARTNERSHIP'_!#;._._ i LLCE f#r
COMPANY NAME Read Rooter Inc I ADDRESS P.O.Box 371
CITY I Sandwich ` STATE MA ,ZIP.02563 ITFL 508 888 6055
FAX 508-888-0242 i CELLrrt _ _ _ ;EMAIL'kis@readyrooter com _ _..
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