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HomeMy WebLinkAboutG-13-601 _. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK UsiVEP VCITY Yarmouth , MA DATE 12/21/12 PERMIT# b13—OO/ JOBSITE ADDRESS 261& 263 Old Town House Road(West Yarmouth) M#861 P#22 OWNER'S NAME:KREC LLC lJ i OWNER ADDRESS 10 Atlantic Ave South Yarmouth, MA 02664 TEL 508-577-7258 ,FAX TYPE OR; OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO0 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. ..._ ,.... . . . - .. DACE GENERATOR GRILLE INFRARED HEATER , LABORATORY COCKS , `MAKE Ball/ NIT OVEN POOL HEATER ROOM / SPACE HEALER - . , ROOF /OP UNIT - - ILSE . UNIT HEATER l�CEPTE� /wt. UNVENTED ROOM HEATER Et WATER HEATER OTHER INSURANCE COVERAGE I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 1. 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 ❑ 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 ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that allot the details and information I have submitted or entered regarding this application are true and accuratet of my ,•- , d that all plumbing work and installations performed under the permit issued for this application will be in compliance with all ent pro ion of •- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER•GASFITTER NAME:James Pazakis LICENSE#PL-15030-M / SIGNA -0: MP ® MGFD ,JP ❑ JGF ❑•LPGI ❑ CORPORATION ® #2803 PARNERRSSHJB'V LLC❑# COMPANY 'NAME Hall Plumbing & Heating, Inc, ADDRESS ` 17 Old Chatham 'Road 7.if .7 l CITY_South Dennis ' STATE MA ZIP 02660 TEL 508-385-9127 FAX 508-385-6604 CELL EMAIL HallTechnicianecomcast.net 1 DEC 26 2012 • • • • r art,4 S3.LON M3IA8 NYld • II11WM3J $ 334 0 0 11151M3d 3H1SV S3A113S N011VOIlddtl SIH1 oN sSA SlJ.ON NOI.L.D3dSNI 7VNIA AINO 3511 HIOJ.J3dSNI HOI 3OVd SIILL S3.LON NOLLO3dSNI SVO 1199021