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G-13-359
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ty y144,a, CITY Yarmouth MA DATE 10/31/12 PERMIT# C`] I9"559 ‘44, ("P‘' JOBSITE ADDRESS 41 Pawkannawakut(Yarmouth) M#32.108/P#2475 OWNER'S NAME: Bevilacqua GOWNER ADDRESS SAME TEL FAX TPPPENOR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL ED CLEARLY NEW: [31 RENOVATION: ❑ REPLACEMENT: © PLANS SUBMITTED: YES 0 NO❑ APPLIANCES 7 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 -FIRE-PUCE FRYOLATOR FURNACE ...GENERATOR- GRILLE -INFRARED HEATER •'SORATORYCOCKS " MAKEUP AIR UNIT OVEN POOL HEATER -ROOMTSPACE`HEATER ROOF TOP UNIT "TEST UNIT HEATER —ONVEI7TED ROOM HEATER 1,NATERAEATER /�; OTHER F trat NSURAN •\ERAGE 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 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 __r11.11 ere•ycart, at aote•etaisan• inormabon ave su•mitte•or en ere• regar•ing is app cation are a an• e•estom now e•gean• tatl all plumbing work and installations performed under the permit issued for this application will be In compliance w ent provision of e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M 1 NATURE MP ® MGT] JP 0 JGF ❑ LPGI ❑ CORPORATION ® #2803 TNERS • r • LLC ❑# COMPANY NAME Hall Plumbing & Heating, Inc, ADDRESS 447 Old C " n CITY South Dennis STATE MA ZIP 02660 TEL 508-385-9127 �( FAX 508-385-6604 CELL EMAIL HallTechnician(acomcast.n NOV 0 2 2012 GJ _.._.T 'BOOING, ;y __ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES i Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE $ PERMIT# • PLAN REVIEW NOTES EH Mora a4