HomeMy WebLinkAboutBLDG-13-173 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
Itr t ti; 1 CITY Yarmouth MA DATE 09/04112 PERMIT# J,�
JOBSITE ADDRESS 39 Rune stone Road(South Yarmouth) M#101 /P#87 OWNER'S NAME:Boguski
GOWNER ADDRESS SAME ' TEL 508-394-2859 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL o RESIDENTIAL
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CLEARLY NEW ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO❑
APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 i 9 10 11 12 13 14
.._BOILER.-.,. .......-_ 1 .
,-
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER I
DRYER
`FIREPLACE
FRYOLATOR `. _ .: .-1
FURNACE ' I
GENERATOR
GRILLE
LABORA OREACOCKS J
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m _. _, _ ._
MAKEUP AIR UNIT ! G ___ .... ..�
OVEN ` �O�ti
POOL HEATER •• 1 ,(.
.ROOM / SPACCREATER _ 0•
ROOF 10P UNI F %)‘Pt 1
TEST — _
UNIT HEATER , ems' , �I ,p
—ONVENTED'"`ROOTA'R ER 9)
"WATER HEATEk -
OTHER {p'4
IAEURANCECOVERAG.
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 I.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 a • _ !est of m nowledge and that
all plumbing work and installations performed under the permit Issued for this application will be in compliance with -nt provision of th
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M ' S
MP ® MGFD ® ,'f1'
JP Q JGF ❑ LPGI 0 CORPORATION #2803 NER• IP ■# LLC p#
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 HallTechnicianf@comcast.net
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES A THE PERMIT ❑ ❑
FEE: $ PERMIT#
PL•. REVIEW NOTES\
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