HomeMy WebLinkAboutG-13-023 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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-F Ii -1t CITY Yarmouth MA DATE 716/2012 PERMIT# 613- 023
JOBSITE ADDRESS 1 Yankee drive OWNER'S NAME Charles Zahigian
GOWNER ADDRESS 1 Yankee drive TEL 508-394-4061 FAX
TYPE OR
PRINT OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL RESIDENTIAL El
CLEARLY NEW:❑ RENOVATION:❑' REPLACEMENT:[-.1 PLANS SUBMITTED: YES I:: NO❑+
APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER x
BOOSTER
a
CONVERSION BURNER 1 •
COOK STOVE
DIRECT VENT HEATERj; - 1�� I I rr 1
DRYER
FIREPLACE 1 i i 1 i . , , I I
GENERATOR an -
GRILLE na
INFRARED HEATER LABORATORY COCKSiiIiIIiIIIIi•II
MAKEUP AIR UNIT 1 , 1_ 4
OVEN • Ii
POOL HEATER
ROOM I SPACE HEATER �'
ROOF TOP UNIT 7- 1- r c
-
. .
UNIT _ _ -
UNIT HEATER _ j-
UNVENTED ROOM HEATER 1 1
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES Q NO Cl
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:lam 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 ❑ AGENT 0
SIGNATURE OF OWNER OR AGENT
1 hereby certify that all of the details and Information I have submitted or entered regarding this application are
nd .. u • e tot e best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in.• tt Perti : t pr sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,
PLUMBER-GASFITTER NAME James Wahtola 1 LICENSE# 24335 IF, SIGNATURE
MP 0 MGF❑ JP❑. JGF❑ LPGI❑ CORPORATION❑# 20351324 PAR 'SHIP❑# LLCID
COMPANY NAME: Wahtola Plumbing 8 Heating ADDRESS 24 Plant road unit 7
CITY Hyannis i I STATE MA TZIP 02601 1 ; TEL 508-778-6868` I ,
FAX 508-862-2129 . CELL 508-294-5273 f EMAIL office@wahtola.com I I I
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_.. .:}._;ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
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THIS APPLICATION SERVES AS THE PERMIT
FEE: S PERMIT#
PLAN REVIEW NOTES