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Home My WebLink AboutG-13-278 MASSACHUSETTS UNIFORM APPUC4T! N FOR A PERMIT TO PERFORM GAS FITTING WORK 't tr4x=,+ CITY Yarmouth: _ MA DATE 10103/12 PERMIT 27e JOBSITE ADDRESS 25 Merl$nount Road (W. Yarmouth) M#;':1:P# ' OWNER'S NAME: Roberts GOWNER ADDRESS SAME TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION: 0 REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO D CO APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER 111111 tCOOK STOVE?f1EAtE R -------------- Milii Illi `DRYER 1111111111111111-01111111111 ®®-1111111111101111111111 FRYOLATOR FURNACE.........•.._,.._.__. _ w ��®=-®===�� ..._..�.,.......,..I EILERATZ7R 1 ..�..M� GRILLE INFRARED HEATER FBORATORYCOO ow P.' 1 OVENMAKEUP`AIR UNITiliiiiill E VIED Ili POOL EATER R = ill tios -OON1"1- HEATER _ 1 NIT HEATER Butt-• _ 1 . NT • seat lie. : r�=�� ® 1 M ATER HEATER' ��staa/eda ss. iiimminm.._.._. iiiEwipasirri 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. CHECK ONE ONLY: OWNER 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 and ac�.,�- •t e!es o m 'now e•ge an• a all plumbing work and installations performed under the permit issued for this application will be in compliance wit .,,•2--ent provision o e ., Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M `/ SIGNATURE MP ® MGFD JP 0 JGF D'LPG! 0 CORPORATION ® #2803 P' # LLC D# . COMPANY NAME Hall Plumbing & Heating, Inc. ADDRESS 447 Old Chatham Road CITY_South Dennis STATE MA ZIP 02660 TEL 508-385-9127 FAX 508-385-6604 CELL EMAIL HallTechnician@comcast.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES • • ate t S tl +' /'..