HomeMy WebLinkAboutG-12-108 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING
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1:__1"'= i; CITYROWN: Yarmouth 1 STATE:MA A'PLICATION DATE;}83011
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JOB ADDRESS:I-...73.w._.Wh.ie__.,.(Zeck-_..—j c ,,.m. . --..i I AU i 3 1 2011
G OCCUPANCY TYPE: COMMERCIAL RESIDENTIAL P NS SUBMITTED:_YES❑ NOD
UUI LANG ULPT.
NEW ALTERATION❑ REPLACEME 0 REMOVALIDEMOLITION❑ 3y'
r NATURAL& LIQUEFIED PETROLEUM GAS:PIPING-EQUIPMENT—APPLIANCES—SYSTEMS 1
ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FIVE(5)NUMERALS
AIR ROTATION UNIT 1 FURNACE: ALL TYPES 1 TEMP HEATING EQUIPMENT rI
BOILER:ALL TYPES GAS PIPING J THERMAL OXIDIZER
BOOSTER GENERATOR(STATIONARY ENGINE) I TURBINE r-1
BROILER ILLUMINATING APPLIANCE I UNIT HEATER r—I
BURNER: ALL TYPES INCINERATOR J WATER HEATER: ALL TYPES rim
---- CO-GENERATION UNIT INDUSTRIAL AIR HANDLER I EQUIPMENT OVER 12,500MBH I —I _
COFFEE ROASTER INFRARED HEATER I (OTHER NOT LISTED1 r—t
COOK APPLIANCE HOUSEHOLD KILN I GLORY HOLE 1 CRUCIBLE j I-1
COOK APPLIANCE COMMERCIAL LABORATORY COCKS
11--1
DECORATIVE APPLIANCE MAKEUP AIR UNIT I Irk
DIRECT VENT APPLIANCE MECHANICAL EXHAUST EQUIPMENT1 11t
DRYER: ALL TYPES OVEN: ALL TYPES II II
FIREPLACE:VENTED!UNVENTED POOL HEATER I I II-1
FRYOLATOR ROOF TOP UNIT I i J
FUEL CELL ROOM HEATER-VENTEDNENTLESS I .1E-1
PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY
NAME: PMG Mechanical Systems LLC. ADDRESS: Po box 797 ❑Corporation Business#
Forestdale ++ MA 02644 Partnership Business# -
CITY: _ . . . ISTATE:Limp:
❑LLC Business# 3329
TEL: 5088881145 FAX.L8883745 a EMAIL:1pmgmechanical@verizon.net I ❑DBAIUnincorporated
NAME OF LICENSED PLUMBER 1 GAS FITTER:
INSURANCE COVERAGE
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES❑ NO❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
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 Massachusetts General
Laws,and that my signature on this permit application waives this requirement
CHECK ONE ONLY
OWNER❑ AGENT ❑
Signature of Owner or Owner's Agent
OWNER'S NAME: ._._._DhutEt.___Ss‘vtcw.cit. I TEL:-2:18-21.644—ti/id FAX, _ --_...j
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I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to
the best of my knowledge.I certify that all plumbing work and Installations performed under the permit Issued,will be In compliance with
all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the General Laws.
(OFFICE USE ONLY) Type of License:
Permit i2I`2-- for ✓❑Plumber ❑GasfitterG`--
Signa ure of Licensed Plumber)Gas Fitter
['Master ❑Journeyman
Inspector
ti0 .W ❑Undiluted LP Installer License Number. 12535
Fee: ' 1
0 Limited LP Installer