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HomeMy WebLinkAboutG-13-360 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK 7tilt / -ye CITY Yarmouth MA DATE 10/31/12 PERMIT# 13-3 b 0 JOBSITE ADDRESS 55 North Main Street(South Yarmouth) M#70/P#8804 OWNER'S NAME: Dionne GOWNER ADDRESS SAME TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIALEDUCATIONALRESIDENTIAL pn PRINT ❑ 0 CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: K PLANS SUBMITTED: YES ❑ NO❑ APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 I 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT—VENT—HEATER DRYER FIREPLACE FRYOLATOR FURNACE U RNNAC OR GRILLE • --1NFRAREDTTEATER `LABORATORY COCKS •MAKEUPAIRUNIT OVEN POOL HEATER •ROOMTSPACEHEATER ROOFTOP UNIT TEST "" I UNIT HEATER UNVENTEb ROOM HEATER 4 –WATER-HEATER 1 OTHER R IN URA` • 'ERAG: 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 tE OTHER TYPE INDEMNITY ❑ 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_ . p ° - NT 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 a a e to e best of m owledge and thafl all plumbing work and installations performed under the permit issued for this application will be in compliance wi Pertin provision • I e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - l PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M SI •ATURE MP ® MGF❑ JP 0 JGF ❑ LPG] ❑ CORPORATION ® #2803 P TNE"HI• i • LLC ❑# COMPANY NAME Hall Plumbing & Heating, Inc, ADDRESS 447 Old Ch ‘) 0 vsz,.‘ CITY South Dennis STATE MA ZIP 02660 TEL 508-385-9127r1;3 , 1 FAX 508-385-6604 CELL EMAIL HallTechnicianan-comcast.net rra NOV 02 2012 ' -SUILDtNGDEPP By 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 r "4 L� t CYr �c 1