HomeMy WebLinkAboutG-11-233 '' A\ MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO DO GAS' 1 E ii Q 1'J M
(Print or
f, t yutzType)oOTl1 mass. Date 10/8/10
20 10 •permit tt I QCT 1 3 RECD
I this a Sheerin C7/�233
-eel . Building Location 27 Standish Way owners Name
West Yarmouth M#30/P#143 I T Res BY
Type of Occupancy
!.fNewfl Renovation Replacement11:1 Plans Submitted: Yetn No n
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SUB-BSMT. •
BASEMENT 1 _
1ST FLOOR
2ND FLOOR
3RD FLOOR'. .
4TH FLOOR v T!-�
6TH FLOOR aC E. TO
• 6TH FLOOR - _ of I
7TH FLOOR �. r
' 13TH FLOOR • _ '
• installing Company Name Hall Plumbing& Heating,IInc. • Check one: Certificate
Address
447 Old Chatham Road • Corporation C-2803
• South Dennis,MA.02660
Partnership
Business Telephone 508-385-9127 �Finn/Co.
Name of Licensed Plumber or Gas Fitter James Pazakia LJ •
INSURANCE COVERAGE
• I have a current liability instrance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. .
. YesL Not
11 you have -ri, please Indicate the type coverage by checking the appropriate box. •
A liability Insurance policy Other type of indemnity❑ Bond
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General taws, and that my signature on this permit application waives this requirement
eck one: -
Owner • Agent n
Signature of Owner or Owner's Agent •
I hereby certify that all of the details and information I have submitted(or entered)in above app!' '. - et6o end atcurate to the sl or my
•knowledge and that all plumbing work and Installations performed under the permit issue. . I s •pf•-tion will be in compile with all
pertinent provisions of the Massachusetts State.Gas Code end Chapter 142 of the Gen 1 Laws:
By T�e of License: . _
• lG Plumber flnature;>• or - aler
Title Gasritter 130-M
Otyrtavn
Master
Journeyman +
APPROVELTramnsrarivr—
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