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HomeMy WebLinkAboutBLDG-16-003837 676) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _CE, CITY Yarmouth ! MA DATE. 12/30/2015 PERMIT# /��/ °' gl) JOBSITE ADDRESS 4 Orchid Street OWNER'S NAME Heather&Matt Childs GOWNER ADDRESS Heather' &Matt Childs TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BOILER _i. BOOSTER CONVERSION BURNER COOK STOVE ..�. ____ n ".__ a-_—__ _ ..__—, 4 ; .A ___.___ ! DIRECT VENT HEATER 1 , DRYER i L 3i FIREPLACE a - 4._: __ ,; - -__, ----- _ .._. W FRYOLATOR ti � 1t ?- —i — FURNACE H ,r GENERATOR ... f__._ r __. GRILLE ! 7. __.__,� � ..__._ _. . _ ; INFRARED HEATER �_ _ - ._..___ ��" _ . LABORATORY COCKS1 ___ j Yv_ _ j,_._ t.__._. MAKEUP AIR UNIT ' OVEN -- _ 4, 1, L ....I' - .. �._.. ^�` 1.,._-. ... 1 v POOL HEATER • ROOM I SPACE HEATER ___ _J_ t_.:� -.--___ ' s _ ROOF TOP UNIT , t-._ .-- ;,-_ _1 r i ---'Y - - -=._. _— 4_.._.- _:- _. _ - -- - ----—r-' i , TEST 1 !-- �1 UNIT HEATER _-- v i __ _ 1 UNVENTED ROOM HEATER , WATER HEATER , --- _ _ OTHER —�r ,w . ,. - + 1 4 f l' . 1. "d INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES C.';NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE INDEMNITY BOND I .C/1' gx7a 86,p,cr' 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 AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in come h all P rtinent r vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r. PLUMBER-GASFITTER NAME Peter J.Hassett i LICENSE# 11682 SI NATURE MP i MGF JP JGF LPG( CORPORATION + # 3506 PARTNERSHIP # LLC # COMPANY NAME: Hassett Plumbing and Heating Inc. ADDRESS 8 Skipper Lane CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555 FAX CELL 508-237-2175 EMAIL hassett357m@msn.cim (\)4 v\