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HomeMy WebLinkAboutG-13-085 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK °� 4.:7;¢ri ]r� �y ' CITY Yarmouth MA DATE 07/30/12 PERMIT# 3 Q a!J S M J JOBSITE ADDRESS 10 Ocean Spray Lane(West Yarmouth) M#56/P#20 OWNER'S NAME: Marino GOWNER ADDRESS SAME TEL 508-771-4814 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO❑ $o,00 APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER __ _ a_ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER �� IFIR PUCE FRYOLATOR FURNACE � 1 1 _,lir�UG �1 GENERATOR I ii EP • GRILLE MU) ' - -INERARED HEATER _ BY LABORATORY COCKS MAKEUP AIR UNIT OVEN �rC I�`Q POOL HEATER FYI "ROOlol l"SPArFIEATER ROOF TOP UNI I TEST UNIT HEATER "OISVENTED 1FOOM HEATER WATER HEA1ER / OTHER i URARCECO�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 ® OTHER TYPE INDEMNITY 0 BOND ❑ 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 at 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 all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M SIGNATURE MP ® MGF❑ JP 0 JGF ❑ LPGI 0 CORPORATION ® #2803 PARTNERSHIP 0# LLC ❑# 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