HomeMy WebLinkAboutG-13-381 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '
tijL`=l CITY Yarmouth MA DATE 11/07/12 PERMIT# 381
•u
JOBSITE ADDRESS 71 South Street(South Yarmouth) M#421 P# 162 OWNER'S NAME: O'Malley I
GOWNER ADDRESS 16 Freeport Drive Burlington, MA 01803 TEL FAX
TPPPENOR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL 0 RESIDENTIAL ®
CLEARLY NEW: 0 RENOVATION: 0 REPLACEMENT: ® PLANS SUBMITTED: YES ❑ NO❑
APPLIANCES-1 FLOORS-. BSM 1 2 3 4 5 6 7 8 j 9 10 11 12 13 1r
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
-DIRECT—/ENT HEATER
DRYER
`FIRE :ACE
FRYOLATOR
FURNACE
-GENERATOR
GRILLE � I
-INFRARED HEATE}2 -- --_-- --� ;� —i
-a19-ORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
-ROOM / SPACE`HF�TER '`�
ROOF (OP UNI f
TEST
UNIT HEATER
'UNTENYED"-ROCNFREATER
WATERBEATER
`*,
OTHER
INSDRANE
' COVERAG
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES LX] 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
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 - •rare • 'nes now e•ge an•t a
all plumbing work and installations performed under the permit Issued for this application will be in compliance wi • .I Pe• provision • the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER- FITTE PNAMEesPaz1503 - I•IGNATURE
❑ MGF❑ 0 JGF 0 PGI ❑ CORPORATION ® #2803 PARTNERSHIP ❑# LLC ❑#
COMPANY NAME Hall Plumbing & Heating, Inc, E 5. ADDRESS 447 Old Chatham Road
g
CITY South Dennis ' STATE MA �R ZII /7.011 ¶/ 508-385-9127
FAX 508-385-6604 CELL i • AIL HallTechniciancomcastnet
II
X19 i#.2-
ru:LJ.X(•;• 7PT i
� '
r ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
y Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 D
FEE: $ PERMIT#
PLAN REVIEW NOTES
e.
1\